…policy, clinical criteria, and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers,

…the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers,

…skills Computer application proficiency Preferred Qualifications: 1+ years of managed care experience; eg case management/health coach, utilization

…management and organization skills. Strong research and analytical skills. Knowledge of managed care preferred. Education: Requires two to four years clinical

…of clinical nursing or case management experience. * 2+ years of related experience in managed care environment. * Unrestricted CA RN license, LCSW, or LMSW. *

…1 year of experience in care management/condition management in a health insurance/ managed care setting PC proficiency to include Word, Excel, Lotus Notes

…Others may be assigned. Performs manual and electronic posting functions for all Managed Care , Commercial and Government payors for all patient accounts,

…under payor contracts. Supports annual budget development and management for the Managed Care and Children's Health Collaborative. Provides guidance and support

…3 years of experience at a manager level or above capacity within a managed care organization with strong leadership and people management background Full

…Implements strategy and service development consistent with patient, referrer, managed - care /payor expectations. Serves as practicing attending physician in