255 Unitedhealth Group jobs in the United States

Works collaboratively with primary care or specialty physicians, their patients and practices to coordinate and process managed care referrals and / or authorizations for patient care services, complying with BIDCO's and BIDMC's contractual rules for Care Coordinator, Support Staff, Coordinator, Management, Healthcare, Patient

The Managed Care Coordinator will coordinate the provision of inpatient chemical dependency treatment services with third party payers, including commercial insurers and managed care companies. He/She will coordinate inpatient care with other assigned staff through entire treatment cycle. Facilitate authorization and concurrent review processes for all third party insured inpatients. Perform comprehensive psychosocial assessments on prospective patients, as needed. Work collaboratively and manage all relevant information from medical, nursing, and counseling staff needed to present patient case to insurance entities to attain proper authorization for patient stays. Maintain and disseminate updated insurance entity information including changes in managing entities, plan changes, hours of operation, contact information and all other relevant information with regards to authorization policies and procedures. Work in conjunction with BHS Central Intake staff on coordination of patient's insurance benefits. Performs care management functions for inpatients, as needed. Maintain relationships with other agencies and individuals wishing to make referrals to the program; coordinate discharges as needed. Remain current on policies and procedures of insurance companies to facilitate coordination of program's financial responsibilities. Maintain and prepare statistical data, reports, and correspondence as required for agency, county and state, as assigned. Maintain clinical records in compliance with all regulatory bodies and SJRH/BHS policies and procedures.

CASAC, LMSW, LMHC or other NYS recognized QHP required. Five or more years of treatment experience specific to chemical dependency treatment is required; inpatient detoxification and rehabilitation experience preferred. 3-5 years of experience dealing with managed care/ insurance companies is required.

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.

IDR is seeking a Managed Care Analyst to join one of our top clients for an opportunity in the Dallas, TX area.

Overview:

The Managed Care Analyst will play a crucial role in moving USPI ASC centers onto a new contract management pricing system. This involves accurately loading and auditing contract profiles, utilizing strong analytical skills and attention to detail. The ideal candidate will have a strong background in financial analysis in the healthcare industry, with expertise in healthcare contracts, reimbursement methodologies, and coding.

Requirements:

• 3+ years of financial analysis experience in the healthcare industry
• Strong knowledge of healthcare contracts and reimbursement methodologies (DRG, APC, CPT/HCPCS, ICD-10)
• Familiarity with Microsoft Excel, including pivot tables and vlookups
• Experience with contract adjudication systems and ability to program contract terms
• Keen attention to detail and strong analytical skills

What's in it for you?

• Competitive hourly rate
• Opportunity to work with a leading healthcare organization
• Flexible schedule, with remote work options after initial 3-month period

Why IDR?

• 20+ years of proven industry experience in 4 major markets
• Employee Stock Ownership Program
• Dedicated Engagement Manager committed to your success

#LI-Hybrid

Marshall Health Network is seeking a full-time Managed Care Analyst. Position responsible for ensuring accuracy of third-party insurance payments according to contractual and state/federal reimbursement guidelines and policy. Identifies underpayments and works with patient accounting department and third-party payor to resolve/appeal. Assist in payor relations and provider contracting. Maintains contract management pricing software. Negotiates single case agreements. Assist in preparation, maintenance, and compliance of pricing transparency requirements and disclosures. Assist in various other financial analysis including:

• Follows standards of conduct and procedures of hospital and applicable laws and regulations and reports violations through appropriate chain of command.
• Performs regular payment reviews of high-risk underpayment areas.
• Reviews payer updates and provider news releases.
• Follows HIPAA guidelines to ensure patient privacy and security.
• Audit patient accounts to reconcile missed or incorrect payments.
• Utilizes technology to maximize review process efficiency.
• Maintains a level of persistency when pursuing an underpayment from a third-party payer.
• Document projects and underpayment recovery collections and efforts.
• Identifies opportunities to maximize third party reimbursement.

Location:Hawaii Cancer CarePay Range:$20.90 - $34.82Job Description Summary: A Managed Care Coordinator serves as the liaison between the Financial Counselor and the Utilization Management and Intake team by coordinating managed care review of benefits, authorizations, referrals and streamlining communication of the managed care components for patient services. Performs the quality control function for pre-certification and prior authorization. The Managed Care Coordinator ensures the patients' insurance benefits are kept up to date in the electronic medical records (EMR) and billing software while also verifying the patient's services meet coverage appropriateness.Primary Job Duties & Responsibilities:Monitors and coordinates internally and externally with the insurance company on the pre-certification and prior authorization processes, including peer-2-peer and appeals, seeking support from provider or pharmacy team when applicable.Review assigned patient(s) and/or Physician schedules for upcoming visits and/or treatment to evaluate coverage criteria with payor guidelines and preferred treatment.Review patients' treatment plan(s) and identify if insurance benefit coverage is active, all unplanned exceptions are to be communicated to provider/clinic team immediately.Review and identify new treatment orders.Communicate openly and routinely throughout the course of the workday with various teams such as the Financial Counselor Team, Intake Team, UM team and coworkers through Teams, phone calls, emails and in person to discuss items as needed to complete managed cares.Work closely with outside entities to ensure full collaboration and completion of forms and items needed in a timely and sometimes urgent manner.Understand and comply with all Federal and State laws and regulations pertaining to patient care, rights, safety, billing, and collections.Will be expected to work overtime when given sufficient notice of required overtime.Keep work area and records in a neat and orderly manner.Maintain all company equipment in a safe and working order.Adhere to all AON and departmental policies and procedures, including Revenue cycle policies and procedures.Performs other duties and projects as assigned.Job Qualifications and Requirements:Education: High school Diploma or GED required. Further education or degree a plus Certifications/Licenses: Previous Experience (including minimum years of experience):A minimum of two-years prior experience in the healthcare field, preferably in a clinical or business office setting required.Prior Medical terminology.Prior Medical insurance verification.Prior Verifying pre-certification and/or prior authorization with medical insurance.Excellent proven verbal and communication skills needed.Proven Insurance knowledge requirements including an understanding of medical terminology, ICD9, ICD10 and CPT codes.Ability to calculate and collect patients' responsibility and insurance co-pay/coinsurance.Core Capabilities:Analysis & Critical Thinking: Critical thinking skills including solid problem solving, analysis, decision-making, planning, time management and organizational skills. Must be detailed oriented with the ability to exercise independent judgment.Interpersonal Effectiveness: Developed interpersonal skills, emotional intelligence, diplomacy, tact, conflict management, delegation skills, and diversity awareness. Ability to work effectively with sensitive and confidential material and sometimes emotionally charged matters.Communication Skills: Good command of the English language. Second language is an asset but not required. Effective communication skills (oral, written, presentation), is an active listener, and effectively provides balanced feedback.Customer Service & Organizational Awareness: Strong customer focus. Ability to build an engaging culture of quality, performance effectiveness and operational excellence through best practices, strong business and political acumen, collaboration and partnerships, as well as a positive employee, physician and community relations.Self-Management: Effectively manages own time, conflicting priorities, self, stress, and professional development. Self-motivated and self-starter with ability work independently with limited supervision. Ability to work remotely effectively as required.Must be able to work effectively in a fast-paced, multi-site environment with demonstrated ability to juggle competing priorities and demands from a variety of stakeholders and sites.Computer Skills: Proficiency in MS Office Word, Excel, Power Point, and Outlook required.Ability to use multiple screens to perform required job functions.Ability to navigate multiple applications and tab in and out of workflow to complete tasks.Travel : 0%Standard Core Workdays/Hours: Monday to Friday 8:00 AM - 5:00 PM. #AONA

Req #: 3397 Job ID: 14854 Job Location: New York, NY Zip Code: 10041 Category: Office and Administrative Support Agency: Medical Associates, P.C. Status: Regular Full-Time Office: Office-based Salary: $38,545.53 - $48,181.92 per year Rooted in Jewish values and traditions, and consistent with the highest standards of quality care, MJHS Health System is a premier provider of health services in the greater metropolitan area and beyond, ensuring access to health, supportive and community-based services across the continuum of need. Our MJHS Medical Associates, P.C. is a group of Nurse Practitioners, Physician Assistants, RN Case Managers and LPN's who provide care to Elderplan members who are residents of assisted living and long term care facilities, as well as to those living at home.The MJHS Difference At MJHS, we are more than a workplace; we are a supportive community committed to excellence, respect, and providing high-quality, personalized health care services. We foster collaboration, celebrate achievements, and promote fairness and belonging for all. Our contributions are recognized with comprehensive compensation and benefits, career development, and the opportunity for a healthy work-life balance, advancement within our organization and the fulfillment of having a lasting impact on the communities we serve.Benefits include: Tuition Reimbursement for all full and part-time staffGenerous paid time off, including your birthday! Affordable and comprehensive medical, dental and vision coverage for employee and family members Two retirement plans ! 403(b) AND Employer Paid PensionFlexible spendingAnd MORE! MJHS companies are qualified employers under the Federal Government's Paid Student Loan Forgiveness Program (PSLF) Responsibilities: Ensure high quality, cost-effective care and services for Elderplan members through support of professionalCare Management and/or Clinical Service activities. This position supports all aspects of care coordination forour ISNP, IESNP and Elderplan Plus members in compliance with all departmental and regulatory requirements.The position requires excellent communication and organizational skills. Qualifications: High School Diploma or equivalent; College Degree preferredOne-year prior managed care experience preferredPrior experience in a health care setting preferredFamiliarity with utilization management/case management

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

Job Summary:Under the direction of the Value Based Coordinator, the LPN - Managed Care, role is to provide clinical expertise for specific complex and/or rising risk patient populations with a design to meet specific contractual and program related requirements. Ensures excellence with transitions of care to achieve optimal clinical outcomes through a seamless model of access and care. Focuses on improving the health status and care for individuals with chronic conditions with complex medical, mental health and psychosocial issues. The LPN - Managed Care demonstrates knowledge and skills to appropriately communicate and interact with staff, patients, families and visitors of all age groups while being sensitive to their cultural and religious beliefs. Job Responsibilities:Act as liaison between healthcare providers, nurse facilities, hospitals, patients and insurance companies to ensure consistent and cost-effective care Evaluate patient's plan of care and make recommendations about care alternatives that will aid in the quality of care for patients while keeping costs low Educate patients and caregivers about preventative healthcare, such as regular doctor's visits and vaccinations, as well as disease management Thoroughly and accurately ensure compliance with ACO and insurances requirements/specifications for annual wellness visitsIdentify members with chronic conditions and / or gaps in care that can be positively impacted, as it relates to quality and care costsCollaborate with the appropriate individuals to offer ideas and solutions to refine and improve existing practices that will enhance patient outcomesDistribute educational information to patients and educate patients on preventive measures Ensure that proactive measures for wellness visits are achievedEnsure follow up so that patients attend needed appointments to address gaps in careEnsure that all needed measures are ordered and appropriately addressed by providers at each visitIdentify gap opportunities for all visits not just wellness visitsClosely assess a patient's emotional, physical, and psychological state in order to ensure they receive timely interventions and quality careEncourage regular doctor visits and staying up to date on vaccinations to help patients maintain their health and to reduce medical costsAssess the care plans of patients and make recommendations to ensure efficacy and cost-effectivenessJob Requirements:Graduate of an accredited school of nursingCurrent Mississippi Board of Nursing LicenseCurrent CPR Basic Life Support (BLS) through American Heart AssociationDemonstrate knowledge and skills in the administration of their duties in addition to performing phlebotomyBasic knowledge of clinical operationsDemonstrates skills in written and oral communicationAbility to comprehend and perform duties with minimal supervisionAbility to prioritize work and accept constructive criticismAbility to prepare reports and follow-up as necessaryMust continuously listen, visualize and have dexterity and eye-hand coordinationMust have full range of body motionMust frequently sit, reach, use both right and left forearm rotation, walk, stand, kneel and twistPhysical and Other Requirements:Continuously listen, visualize, and have dexterity and eye-hand coordinationFrequently sit, squat, reach, use both right and left forearm rotation, walk and standOccasionally kneel, twist, have ability to grasp firmly, lift and carry, push and pull in excess of 10 lbs.