Directs and oversees all policies and procedures for the financial and data operations of managed care contracts. Manages contracts, negotiates and sets rates, and reviews reimbursement levels and managed care agreements to ensure that proper payment practices are utilized. Implements processes that encourage and inform the organization how to increase levels of reimbursements. Requires a bachelor's degree. Typically reports to top management. Manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function a more...

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The Managed Care Finance Operations Director manages contracts, negotiates and sets rates, and reviews reimbursement levels and managed care agreements to ensure that proper payment practices are utilized. Directs and oversees all policies and procedures for the financial and data operations of managed care contracts. Being a Managed Care Finance Operations Director requires a bachelor's degree. Implements processes that encourage and inform the organization how to increase levels of reimbursements. In addition, Managed Care Finance Operations Director typically reports to top management. The more...

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Directs an organization's financial policies, planning, reporting and controls. Oversees all financial functions including accounting, budget, credit, risk, tax, and treasury. Generally is the second most senior finance executive. Requires a master's degree in accounting or finance or equivalent. May require the Certified Public Accountant (CPA) credential. Typically reports to chief financial officer (cfo). Manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedu more...

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Coordinates utilization reviews of managed care contracts using established guidelines and processes. Ensures all clinical operations comply with Medicare and Medicaid guidelines and other managed care policies. Communicates with physicians, discharge planners and others to process referrals, authorization for services, and capture data related to utilization. Maintains managed care contracts and information databases and prepares reports. Typically requires an associate degree in nursing. Typically reports to a supervisor or manager. Typically requires Registered Nurse (RN). Has gained full p more...

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Supervises and coordinates activities of personnel in the managed care operations department of a healthcare facility. Oversees staff that process referrals, authorizations, billing, utilization review, and capitation for hospital services. Experienced in utilization review techniques and protocols. Requires a bachelor's degree. Typically reports to a manager or head of a unit/department. May require Registered Nurse (RN). Makes day-to-day decisions within or for a group/small department. Has some authority for personnel actions. Supervises a group of primarily para-professional level staffs. more...

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There is currently no job description for Managed Care Pharmacist. Be the first to submit the job responsibilities for a Managed Care Pharmacist.

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Develops and implements marketing plans for a managed care organization. Promotes the organization's services to potential members and business partners. Identifies and targets new opportunities and sources of additional business and revenue. Requires a bachelor's degree. Typically reports to a head of a unit/department. Typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Capable of resolving escalated issues a more...

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Directs operations to manage and maintain the customer's inventory replenishment levels and stock models based on approved schedule and agreed-upon targets. Monitors and analyzes utilization, product availability, pricing, and lead times to prepare VMI models. Understands all VMI parameters, calculations and data feeds to accurately generate replenishment orders. Develops reports to track all metrics and identify trends or issues that impact inventory levels. Expedites and resolves any shipping, delivery, ordering or system issues that may impact expected inventory replenishment targets. Requi more...

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The Finance Director - Budgets designs and develops budgetary principles and guidelines to optimize the budget and leads the work of budget department. Manages and controls an organization's budget, overseeing all budgeting activities. Being a Finance Director - Budgets requires a bachelor's degree. Analyzes the variation between actual and estimated budget and produces reports for the Board of Directors to make decisions. In addition, Finance Director - Budgets typically reports to a head of a unit/department or top management. The Finance Director - Budgets manages a departmental sub-functio more...

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Plans and directs all aspects of an organization's managed care function. Responsible for directing and implementing managed care systems for healthcare facilities. Requires a bachelor's degree. Typically reports to a top management. Manages a departmental function within a broader corporate function. Develops major goals to support broad functional objectives. Approves policies developed within various sub-functions and departments. Typically requires 8+ years of managerial experience. Comprehensive knowledge of the overall departmental function. more...

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