Managed Care Jobs in Hackensack (NJ)
- Types/data entry...
as a leader of positive change.
The Case Management Care Coordinator, Utilization Management is a member of the healthcare team and is responsible for coordinating, communicating, and facilitating the clinical progression of the patient's treatment...
of claims, controlling denials, evaluating staff, time and attendance and all other aspects of department needs. Primarily responsible for HMO, Blue Cross Blue Shield ManagedCare, Government payers and Commercial accounts, as assigned, in the the HMH...
- Reports collection efforts/issues for high dollar accounts to management at monthly meetings.
- Processes third party vouchers and verifies accuracy and timeliness of payment.
- Reconciles managedcare payments to the explanation...
- Current working knowledge of discharge planning, CMS regulations, case management, performance improvement, and managedcare reimbursement.
- Understanding of pre-acute and post-acute venues of care...
as a leader of positive change.
The Appeal Nurse Specialist will be responsible for the timely review and submission of appeals for denied managedcare inpatient and/or outpatient claims to insurance companies for reconsideration of denials and/or level...
- Types/data entry...
denials and payment variances. Disciplines include but are not limited to Patient Accounting, Case Management, Health Information, Clinical, Training, ManagedCare, Outsource Partners, Practice Management and DTS . Duties performed are at multiple sites...
- Participation in ManagedCare Contracting & distribution of contract terms where appropriate
- Utilization Review Process
- Subject Matter Expert in the use & application of Utilization Management Criteria...
intensive screening of all Medicare, Medicaid and managedcare patients to identify network status and coordination of benefits. Obtains all applicable patient consents/attestations. Performs job related functions including, but not limited to, facility...
intensive screening of all Medicare, Medicaid and managedcare patients to identify network status and coordination of benefits. Obtains all applicable patient consents/attestations. Performs job related functions including, but not limited to, facility...