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View salary and benefits informationCoordinates 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...
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...
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...
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...
There is currently no job description for Managed Care Pharmacist. Be the first to submit the job responsibilities for a Managed Care Pharmacist.
Supervises teams and operations that manage and maintain the customer's inventory replenishment levels and stock models based on approved schedule and agreed-upon targets. Monitors and analyzes utilization, product availability, pricing, and lead times to prepare VMI models. Understands all VMI parameters, calculations and data feeds to accurately generate replenishment orders. Develops reports to track all metrics and identify trends or issues that impact inventory levels. Expedites and resolves any shipping, delivery, ordering or system issues impacting expected inventory replenishment targe more...
Manages and maintains the customer's inventory replenishment levels and stock models based on approved schedule and agreed-upon targets. Monitors and analyzes utilization, product availability, pricing, and lead times to prepare VMI models. Understands all VMI parameters, calculations and data feeds to accurately generate replenishment orders. Develops reports to track all metrics and identify trends or issues that impact inventory levels. Expedites and resolves any shipping, delivery, ordering or system issues that may impact expected inventory replenishment targets. Requires a bachelor's deg more...
Directs operations to manage and maintain the customer's inventory replenishment levels and stock models based on approved schedule and agreed-upon targets. Monitors and analyzes utilization, product availability, pricing, and lead times to prepare VMI models. Understands all VMI parameters, calculations and data feeds to accurately generate replenishment orders. Develops reports to track all metrics and identify trends or issues that impact inventory levels. Expedites and resolves any shipping, delivery, ordering or system issues that may impact expected inventory replenishment targets. Requi more...
Plans and directs all aspects of an organization's oncology services policies, standards, and programs. Responsible for strategic clinical relationships with physicians and interns. Ensures oncology clinical programs are in compliance with all applicable regulations. Researches and studies current medical publications and data on new treatments and practices to ensure high quality clinical service offerings. Advises non-medical management on clinical and patient related matters and policies. Requires a MD. Typically reports to top management. Manages a departmental sub-function within a broade more...
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...
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