…as skilled, NHP or Boarding Home as appropriate. + Review cases with the managed care companies (or designee). + Complete precertification of all admissions that

…in strategy development and account management, in the PBM, specialty pharmacy, and/or managed care industry. + 15+ years of relevant work experience performing

…facilitate timely start and continuity of transplant services. Works in conjunction with managed care department for both facility & professional contracts for

…planning, home health care , rehabilitative medicine, community health or managed care . Teaching experience preferred. Excellent verbal communication and

…information utilizing internal or electronic sources. + Obtains and documents managed care referrals, required pre-certifications and authorizations as necessary

…payer regulations and processes. You will possess a thorough understanding of managed - care concepts and length-of-stay management relating to patient and

…system, or health plan. Experience with hospital organized medical staff, managed care organizations, and continuous quality improvement activities preferred.

…appropriate community agencies and organizations, the TRICARE Lead Agent office, and the Managed Care Support Contractor. + Maintain adherence to JCAHO, URAC,

…hospital reimbursement as it relates to different payers such as Medicare, Medi-cal, Managed Care and private insurance plans. Riverside Community Hospital is a

…hospital entities, departments, marketing, finance, recruitment, operations, compliance, managed care , credentialing/enrollment, human resources, and information