…the VA and works with these patients utilizing rules set forth by the VA for co- managed care . + Completes any and all clinical reminders "due" at the time of

…government and private payers. Maintains knowledge of services that are covered by managed care organizations and the government payers. + Reviews all inbound

…make an impact** **Required Qualifications** + 3 plus years in a physician office, health care , or managed care environment + Strong experience in ICD-9,

…and/or trauma upon the patient and their support system. + Advanced knowledge of managed care and public programs such as those funded by Medicare, Medicaid,

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

…five years of management experience in one of the following venues: hospitals, managed care , credentialing verification organizations, or ambulatory care .

…anticipation of the patient's movement through the healthcare system. + Interacts with managed care / third party payers to obtain financial certification for

…knowledge and skills: + Excellent clinical skills. + Knowledge and experience in a managed care delivery system. + Knowledge of clinical outcomes and quality

…Nursing -REQUIRED **Preferred Qualifications** + 2 Years Health Plan or Medical Group Managed Care experience. + 2 Years Population Health experience. +

…requirement. Remains current on referral policies and procedures, payer requirements, managed care matrix, portals and determines financial responsibility for