… care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral

…information utilizing internal and electronic sources. 23. Obtains and documents managed care referrals, required pre-certifications and authorizations as

…experience in inpatient case management, social work or utilization management or in the managed care /payer environment, of which one year must have been in a

…abreast of regulatory processes and payer systems such as Medicare, Medicaid, managed care , and private sources, as applicable. Demonstrate extensive advanced

…long and short-range changes in the reimbursement environment including Medicare, Medicaid, Managed Care , and Commercial medical and pharmacy plans while

…+ **Leadership & Utilization Management:** Prior leadership role in a managed care environment and possess strong utilization management experience.

…States** Allied Health UTMB Health Requisition # 2401374 The mission of Correctional Managed Care is to address the healthcare needs of underserved patient

…license in Ohio + At least 2 years of experience with Federal Medicare/Medicaid and Managed Care reimbursement system management in working with the MDS and RAI

…for each person served. + Maintains a functional understanding of funding, managed care requirements, and licensing requirements for each person served.

…packages to help members deal with socioeconomic and medical barriers. + Navigate managed care plans for community services and programs. + Case management