10 Managed Care Jobs

As a Utilization Management Specialist/Prior Authorization Specialist, you will be responsible for reviewing medical information to ensure the necessity of healthcare services and adherence to best practices. Your role will involve supporting the approval of cost-effective healthcare services that meet patient needs. Key Responsibilities: - Review outpatient procedures, inpatient admissions, home health, and behavioral health services to determine their necessity. - Collaborate with providers and medical directors to obtain prior authorization and plan for case reviews as required. - Work with clinical staff to ensure appropriate care and resource utilization. - Participate in quality improv...

As a Quality Analyst, your role involves supporting quality auditing, analysis, reporting, and developing plans to achieve positive outcomes. You will work on risk identification, diagnosing issues, identifying process improvement solutions, and implementing improvement methods. Continuous engagement and collaboration with the Operations and Training Team is essential for success. Key Responsibilities: - Ensure that project-related quality processes are followed by denials analyst and that client-specific and internal metrics are achieved - Prepare detailed reports on audit findings and understand quality requirements from both process and target perspectives, delivering reports in a timely ...

In this role, you will be responsible for performing day-to-day billing activities with accuracy and adherence to firm policies. You will also conduct thorough reviews of billing activities, ensuring accurate and reliable data. Additionally, you will follow up on billing for managed care/private insurances and Medicare for skilled nursing facilities to resolve outstanding balances, denials, and discrepancies. It will be your responsibility to verify claims accuracy by ensuring alignment with Medicaid, Medicare, and private insurance guidelines. You will also process co-insurance, Medicare Part B, and therapy filings. Maintaining organized records and documentation for audits and compliance p...

As an US Registered Nurse - clinical experience at Mangalore, your role overview includes performing medical necessity and clinical reviews of authorization requests, analyzing authorization requests for medical necessity, and understanding US healthcare business. Your key responsibilities will involve: - Senior SME Skillset: Training, Data Management and reporting, Quality Tools, Descriptive Analysis, New project Implementation - Perform medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and Standard Operating procedures - Clinical knowledge and ability to analyze authorization requests and d...

About AstraZeneca AstraZeneca is a global, science-led, patient-focused biopharmaceutical company that focuses on the discovery, development and commercialization of prescription medicines for some of the world's most serious diseases. But we're more than one of the world's leading pharmaceutical companies. Typical Accountabilities Drives product pricing analysis and recommendation by analyzing competitive products and pricing, ensuring alignment with brand value proposition, understanding customer groups (patients and physicians), collaborating with Managed Markets and Contracting Strategy, and leading Pricing Strategy discussions Monitors environment and practices for shifts in trends or b...

At Medtronic you can begin a life-long career of exploration and innovation, while helping champion healthcare access and equity for all. You'll lead with purpose, breaking down barriers to innovation in a more connected, compassionate world. A Day in the Life Medtronic is expanding their footprint for Diabetes Care with a center in Pune and as a Billing Senior Executive for Patient Financial Services, India, this role is responsible for ensuring the accuracy and completeness of billing and charges within the revenue cycle. This role involves reviewing, correcting, and processing billing errors, charge discrepancies, and claims denials within Patient Financial Services. The Diabetes Operatin...

By clicking the Apply button, I understand that my employment application process with Takeda will commence and that the information I provide in my application will be processed in line with Takeda's Privacy Notice and Terms of Use. I further attest that all information I submit in my employment application is true to the best of my knowledge. Job Description: Title Sr. MSL/ MSL Vaccines North 2: Location Delhi: Job Description: About the role Medical Science Liaison, Senior Medical Science Liaison The Medical Science Liaison, Senior Analyst is responsible for managing projects and processes related to medical products throughout their lifecycle. This role involves gathering user requiremen...

You have a minimum of 5 years of experience in the US Healthcare industry. Your expertise includes: - Claims processing - Medical Billing experience in Medicare or commercial line - Experience in Contract configuration, with specific knowledge on Division of Financial responsibility work - Strong knowledge of Managed Care, specifically Medicare Advantage, Commercial, or Medi-cal - Ability to translate agreements/contracts into a matrix for codification - Contract interpretation - Understanding of financial responsibility related to healthcare (Division of Financial Responsibility) - Understanding of contracting - Extensive understanding of billing including service code, rev code, diagnosis,...

The Insurance Coordinator plays a crucial role in the healthcare revenue cycle, ensuring accurate insurance verification, pre-authorizations, claims submission, and follow-up. By coordinating insurance benefits and minimizing financial barriers for patients, this role supports access to care while upholding compliance with healthcare regulations. Key Responsibilities: Insurance Verification & Authorization: - Verify patient insurance coverage and benefits before appointments and procedures. - Obtain prior authorizations and referrals required by insurers for medical services. - Communicate any insurance limitations or requirements to clinical and administrative staff. Claims Processing & Fol...

We are seeking a motivated and detail-oriented Utilization Management Specialist to join our team. In this role, you will play a crucial part in reviewing medical information to ensure the necessity of healthcare services and adherence to best practices. Your responsibilities will include supporting the approval of cost-effective healthcare services that align with patient needs. You will be tasked with reviewing outpatient procedures, inpatient admissions, home health, and behavioral health services to determine their necessity. Collaborating with providers and medical directors to obtain prior authorization and plan case reviews when necessary will be an essential aspect of your role. Addi...