… care for substance use and co-occurring disorders. + Familiarity with managed care principles, insurance authorizations, and payer requirements. + Bachelor's

…United States** Physician UTMB Health Requisition # 2403818 The mission of Correctional Managed Care is to address the healthcare needs of underserved patient

…appropriate inpatient nursing floor. + Obtains precertification as required by patients' health care insurers or managed care providers. Utilizes knowledge

…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,

…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,

…regarding the patient's care to include ensuring compliance with managed care , commercial insurance, and public insurance requirements, submitting and

…timeframes. + Maintains comprehensive knowledge of reimbursement coverage from third party payers, managed care plans and protocols for referrals. + Ensures all

…equivalent experience. **Required Experience** At least 7 - 10 years of experience in Managed Care and/or health plan quality. Clinical experience is needed for

…of provider relations, provider claims/reimbursement, or contracting experience. Knowledge of health care , managed care , Medicare or Medicaid. Bachelor's

…decision-making skills. + Knowledge of insurance regulations, specifically Medicare, BC/BS, managed care plans and workers compensation carriers regarding