…**Preferred Qualifications:** + Previous **Utilization Management** experience + Familiarity with ** managed care ** , **TJC** , **CMS** standards, and performance

…(CCM), Accredited Case Manager (ACM-RN), or UM Certification Training: + Knowledge of managed care and payer environment preferred. + Must have critical thinking

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

…+ Working knowledge of third party payor reimbursement - Medicare, Medicaid, Managed Care and commercial insurance. **Licenses and Certifications** **Working

…each payor within the patient population * Provides the clinical information requested by the managed care companies as part of the concurrent review in a timely

…may include, but is not limited to the Emergency Department log, physicians, nurses, Managed Care and the clients themselves. b. Screens all potential case

…Work, Counseling, Education, or related field and 3 years' experience in Acute or Managed Care / experience with Medicaid or Medicare populations. OR + Bachelor's

…SKILLS & ABILITIES** : * 5-7 years experience in Healthcare Administration, Managed Care , Provider Contracting and/or Provider Services, including 2+ years

…requirements and quality standards are being monitored effectively.Maintain an understanding of basic managed care concepts and principles including Managed

…+ Maintain a working knowledge of Federal and State regulations and reimbursement ( Managed Care , Medicare, and Medicaid). + Provide assistance with new