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Alternate job titles: Benefits Systems Analyst - Healthcare | Benefits Database Systems Administrator

The Managed Care Benefits Systems Analyst runs analysis to verify accuracy of system. Implements and maintains benefits system for managed care and provider data. Being a Managed Care Benefits Systems Analyst requires a bachelor's degree. Assists with training of fee loading processes and ensures coding and schedules are accurate. In addition, Managed Care Benefits Systems Analyst typically reports to a manager or head of a unit/department. Being a Managed Care Benefits Systems Analyst contributes to moderately complex aspects of a project. Work is generally independent and collaborative in na more...



Alternate job titles: Managed Care Finance Operations Director

Directs and oversees all policies and procedures for the financial and data operations of managed care contracts. Manages contracts, negotiates and sets rates, and reviews reimbursement levels and managed care agreements to ensure that proper payment practices are utilized. Implements processes that encourage and inform the organization how to increase levels of reimbursements. Requires a bachelor's degree. Typically reports to top management. Manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function a more...


Alternate job titles: Clinical/Hospital Pharmacist | Registered Pharmacist | RPh

There is currently no job description for Managed Care Pharmacist. Be the first to submit the job responsibilities for a Managed Care Pharmacist.


Alternate job titles: Care and Utilization Review Nurse Coordinator

Coordinates utilization reviews of managed care contracts using established guidelines and processes. Ensures all clinical operations comply with Medicare and Medicaid guidelines and other managed care policies. Communicates with physicians, discharge planners and others to process referrals, authorization for services, and capture data related to utilization. Maintains managed care contracts and information databases and prepares reports. Typically requires an associate degree in nursing. Typically reports to a supervisor or manager. Typically requires Registered Nurse (RN). Has gained full p more...



Alternate job titles: Care and Utilization Review Nurse Manager

Supervises and coordinates activities of personnel in the managed care operations department of a healthcare facility. Oversees staff that process referrals, authorizations, billing, utilization review, and capitation for hospital services. Experienced in utilization review techniques and protocols. Requires a bachelor's degree. Typically reports to a manager or head of a unit/department. May require Registered Nurse (RN). Makes day-to-day decisions within or for a group/small department. Has some authority for personnel actions. Supervises a group of primarily para-professional level staffs. more...


Alternate job titles: Healthcare Plan/Network Product Marketing Manager

Develops and implements marketing plans for a managed care organization. Promotes the organization's services to potential members and business partners. Identifies and targets new opportunities and sources of additional business and revenue. Requires a bachelor's degree. Typically reports to a head of a unit/department. Typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Capable of resolving escalated issues a more...



Alternate job titles: Top Managed Care Executive | Vice President - Managed Care

The Chief Managed Care Officer is responsible for directing and implementing managed care systems for healthcare facilities. Plans and directs all aspects of an organization's managed care function. Being a Chief Managed Care Officer typically reports to top management. Requires a bachelor's degree. The Chief Managed Care Officer manages a departmental function within a broader corporate function. Develops major goals to support broad functional objectives. Approves policies developed within various sub-functions and departments. Comprehensive knowledge of the overall departmental function. Wo more...


Alternate job titles: Top Managed Care Executive | Chief Managed Care Officer

The Vice President - Managed Care is responsible for directing and implementing managed care systems for healthcare facilities. Plans and directs all aspects of an organization's managed care function. Being a Vice President - Managed Care typically reports to top management. Requires a bachelor's degree. The Vice President - Managed Care manages a departmental function within a broader corporate function. Develops major goals to support broad functional objectives. Approves policies developed within various sub-functions and departments. Comprehensive knowledge of the overall departmental fun more...


Alternate job titles: Chief Managed Care Officer | Vice President - Managed Care

Plans and directs all aspects of an organization's managed care function. Responsible for directing and implementing managed care systems for healthcare facilities. Requires a bachelor's degree. Typically reports to a top management. Manages a departmental function within a broader corporate function. Develops major goals to support broad functional objectives. Approves policies developed within various sub-functions and departments. Typically requires 8+ years of managerial experience. Comprehensive knowledge of the overall departmental function. more...



Alternate job titles: Physician Network Relationship Manager

Develops, manages, and sustains relationship with members of physician network of managed care service providers. Recruits new physicians and manages the credentialing and orientation process. Serves as a resource for physicians, answering questions and providing information about network procedures or contracts. Monitors provider performance and resolves any issues. Reviews billings and claims payments according to managed care contracts. Requires a bachelor's degree. Typically reports to the head of a unit/department. Manages subordinate staff in the day-to-day performance of their jobs. Tru more...


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