Managed Care Staffers Jobs in Usa
42,703 positions found
Title: Managed Care Contract Analyst
Duration: Full-Time
Location: Dalton, GA - Remote or Hybrid
Working Schedule: 8:30 AM - 5:00 PM
Position Overview
The Managed Care Contract Analyst is responsible for the day-to-day management, modeling, and performance analysis of payer contracts. This role partners closely with the Director of Managed Care Contracting to support contract negotiations, reimbursement modeling, and ongoing payer performance monitoring. The analyst will interpret complex contract language, identify reimbursement trends and issues, and support revenue cycle optimization initiatives.
Key Responsibilities
- Manage and maintain payer contracts, including inventory of agreements, rate grids, and contract terms.
- Support contract negotiations through data extraction, analysis, and complex reimbursement modeling.
- Model and assess payer reimbursement performance and identify trends in payment practices.
- Identify and assist with revenue cycle reimbursement issues and communicate findings to stakeholders.
- Interpret complex administrative and financial contract language and clearly communicate impacts internally and externally.
- Stay current on payer billing and reimbursement changes and proactively communicate updates.
- Interface with outside vendors and consultants as needed.
- Complete credentialing and re-credentialing applications.
- Ensure accuracy and integrity of contract management systems and data.
Education
- Bachelor’s degree in Business, Accounting, Finance, or Healthcare Management
Experience
- 3–5+ years of healthcare managed care or payer contract management experience.
- Strong understanding of payer contract language and reimbursement methodologies.
- Hands-on experience with:
- CPT, ICD-9, and modifiers
- Hospital Medicare and Medicaid fee schedules
- Third-party billing requirements and claim payment methodologies
- Claim system requirements, procedures, and controls
Skills
- Advanced proficiency in Excel; working knowledge of Word and PowerPoint.
- Strong analytical skills with high attention to detail.
- Excellent written and verbal communication skills.
- Experience with contract management software or strong technical aptitude to learn quickly.
Location: Columbia, SC 29203
Work Environment: (Remote after 4-6 weeks of Onsite training)
Contract length: 4 months assignment with possible conversion
Schedule: Mon - Fri, 40hrs
Job Summary:
Duties/About the role:
Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and established clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency, claims knowledge/analysis, and comprehensive knowledge of healthcare continuum to assess, plan, implement, coordinate, monitor, and evaluate medical necessity, options, and services required to support members in managing their health, chronic illness, or acute illness. Utilizes available resources to promote quality, cost effective outcomes.
Day to Day:
- 50% Performs medical or behavioral review/authorization process. Ensures coverage for appropriate services within benefit and medical necessity guidelines. Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.). Participates in data collection/input into system for clinical information flow and proper claims adjudication. Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but is not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal).
- 25% Provides discharge planning and assesses service needs in cooperation with providers and facilities. Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions. Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits. Collaborates with client's Care Management and other areas to ensure proper care management processes are executed within a timely manner. Manages assigned members and authorizations through appropriate communication.
- 15% Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members.
- 5% Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans. May identify, initiate, and participate in on-site reviews. Promotes enrollment in care management programs and/or health and disease management programs. 5% Maintains current knowledge of contracts and network status of all service providers and applies appropriately. Assists with claims information, discussion, and/or resolution and refers to appropriate internal support areas to ensure proper processing of authorized or unauthorized services.
Job Requirements:
Required Education: Associate Degree - Nursing, OR, Graduate of Accredited School of Nursing,
Required Experience: 4 years recent clinical in defined specialty area. Specialty areas include: oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review/case management/clinical/or combination; 2 of the 4 years must be clinical.
Required License/Certificate: An active, unrestricted RN license from the United States and in the state of hire OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
Preferred Education: Bachelor's degree- Nursing.
Preferred Work Experience: 7 years-healthcare program management.
Preferred Licenses and Certificates: Case Manager certification, clinical certification in specialty area.
Location: Columbia, SC 29229
Work Environment: Remote (after 1 week of Onsite training)
Schedule: Mon - Fri, 8:30 AM - 5:00 PM (Two late shifts, 11:30 am - 8:00 pm - no late shifts on Fridays)
Contract length: 3 months assignment with possible extension
Job Summary:
Duties/About the role:
Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and established clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency, claims knowledge/analysis, and comprehensive knowledge of healthcare continuum to assess, plan, implement, coordinate, monitor, and evaluate medical necessity, options, and services required to support members in managing their health, chronic illness, or acute illness. Utilizes available resources to promote quality, cost effective outcomes.
Day to Day:
- 60% Provides active case management, assesses service needs, develops and coordinates action plans in cooperation with members, monitors services and implements plans, to include member goals. Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions. Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits. Provides telephonic support for members with chronic conditions, high risk pregnancy or other at risk conditions thatconsist of: intensive assessment/evaluation of condition, at risk education based on members' identified needs, provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to change assessment to elicit behavior change and increase member program engagement.
- 20% Performs medical or behavioral review/authorization process. Ensures coverage for appropriate services within benefit and medical necessity guidelines. Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.). Participates in data collection/input into system for clinical information flow and proper claims adjudication. Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but isnot limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal).
- 10% Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans. May identify, initiate, and participate in on-site reviews. Serves as member advocate through continued communication and education. Promotes enrollment in care management programs and/or health and disease management programs.
- 5% Maintains current knowledge of contracts and network status of all service providers and applies appropriately. Assists with claims information, discussion, and/or resolution and refers to appropriate internal support areas to ensure proper processing of authorized or unauthorized services.
- 5% Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members.
Job Requirements:
Required Education:?
Associate Degree - Nursing or Graduate of Accredited School of Nursing or Master's degree in Social Work, Psychology, or Counseling.
Required Work Experience: 4 years recent clinical in defined specialty area. Specialty areas include: oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review/case management/clinical/or combination; 2 of the 4 years must be clinical.
Required License and Certificate: Active, unrestricted RN licensure from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), OR, active, unrestricted LMSW (Licensed Master of Social Work) licensure from the United States and in the state of hire, OR active, unrestricted licensure as Counselor, or Psychologist from the United States and in the state of hire.
Preferred Education: Bachelor's degree- Nursing.
Preferred Work Experience: 7 years-healthcare program management, utilization review, or clinical experience in defined specialty. Specialty areas are oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic, general medicine/surgery.
Medical Director Physician Opportunity - Palm Springs, California
Cutting Edge Managed Care Organization
About the Opportunity:
Join a well-established group in California with over 40 years of dedicated service, focusing on population health. Become a part of a leadership team at the forefront of advancing health initiatives. This opportunity offers a team-oriented approach to patient care, with excellent sub-specialty support and recognition for an award-winning work environment.
Requirements:
- MD/DO degree required
- Licensed in California
Job Highlights:
- No direct clinical responsibilities, allowing for a focus on prior authorization, concurrent review, and utilization management
- A part of one of the flagship ACOs, now a 2nd generation ACO
Compensation & Benefits:
- $500,000 competitive salary with aggressive incentives
- Comprehensive benefits package
Location:
- Palm Springs is known for its beauty, cultural attractions, and community
- Enjoy a scenic environment with year-round sunshine
- Home to various world-class resorts and spas
- Family Medicine
- Geriatrics Smaller patient panels Join an expanding state-of-the-art senior care practice Convenient family-friendly locations in Memphis Staff of talented primary and specialty care physicians Collaborative and team-based approach to geriatric care Outpatient only setting with 1:10 or better phone call Small patient panel to ensure great work-life balance and schedule Compensation and Benefits Competitive base salary ($250,000) and Annual Bonus Potential $25,000 Commencement Bonus Potential Health, dental, 401K, retirement planning, long-term disability & life insurance Community Enjoy working in the heart of Tennessee There is easy access to all of the golf, outdoor activities, parks,restaurants, and entertainment in Memphis
**** Candidates must reside in New York.*****
JOB DESCRIPTION Job Summary
Leads and manages multidisciplinary team of healthcare services professionals in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and/or other special programs. Ensures members reach desired outcomes through integrated delivery and coordination of care across the continuum, and contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
• Responsible for leading and managing performance of one or more of the following activities: care review, care management, utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), transition of care, health management, behavioral health, long-term services and supports (LTSS), and/or member assessment.
• Facilitates integrated, proactive healthcare services management - ensuring compliance with state and federal regulatory and accrediting standards and implementation of the Molina clinical model.
• Manages and evaluates team member performance, provides coaching, employee development and recognition, ensures ongoing appropriate staff training, and has responsibility for selection, orientation and mentoring of new staff.
• Performs and promotes interdepartmental/multidisciplinary integration and collaboration to enhance continuity of care.
• Oversees interdisciplinary care team (ICT) meetings.
• Functions as hands-on manager responsible for supervision and coordination of daily integrated healthcare service activities.
• Ensures adequate staffing and service levels and maintains customer satisfaction by implementing and monitoring staff productivity and other performance indicators.
• Collates and reports on care access and monitoring statistics including plan utilization, staff productivity, cost-effective utilization of services, management of targeted member population, and triage activities.
• Ensures completion of staff quality audit reviews; evaluates services provided, outcomes achieved and recommends enhancements/improvements for programs and staff development to ensure consistent cost-effectiveness and compliance with all state and federal regulations and guidelines.
• Maintains professional relationships with provider community, internal and external customers, and state agencies as appropriate, while identifying opportunities for improvement.
• Local travel may be required (based upon state/contractual requirements).
Required Qualifications
•At least 7 years experience in health care, and at least 3 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience.
• At least 1 year of health care management/leadership experience.
• Must be a Registered Nurse (RN), Clinical licensure and/or certification required ONLY if required by state contract (Preferably New York), regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.
• Experience working within applicable state, federal, and third party regulations.
• Demonstrated knowledge of community resources.
• Proactive and detail-oriented.
• Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
• Ability to work independently, with minimal supervision and demonstrate self-motivation.
• Responsive in all forms of communication, and ability to remain calm in high-pressure situations.
• Ability to develop and maintain professional relationships.
• Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
• Excellent problem-solving and critical-thinking skills.
• Excellent verbal and written communication skills.
• Microsoft Office suite/applicable software program(s) proficiency.
Preferred Qualifications
• Registered Nurse (RN). License must be active and unrestricted in state of practice.
• Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification.
• Medicaid/Medicare population experience.
• Clinical experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $73,102 - $171,058 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Remote working/work at home options are available for this role.
JOB DESCRIPTION
Opportunity for a TX licensed RN, residing in Texas, with experience functioning as a Care Manager working with Complex/Intensive cases. Telephonically you will complete assessments needed for determining the types of services we need to provide and managing their care until they are discharged from your service. The ideal candidate will have experience as a Case Manager within a managed care organization (MCO) like Molina, but we also consider RNs with a strong background in complex cases. Hours are Monday – Friday, 8 AM – 5 PM CST working from home.
Solid experience with Microsoft Office Suite is necessary, especially with Outlook, Excel, and Teams as well as being confident in moving between different programs to complete the necessary forms and documentation. Excellent computer skills and attention to detail are very important to multitask between systems and talking with members on the phone while entering accurate contact notes. This is a fast-paced position and productivity is important.
Job Summary
Provides support for care management/care coordination long-term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
• Completes comprehensive member assessments within regulated timelines, including in-person home visits as required.
• Facilitates comprehensive waiver enrollment and disenrollment processes.
• Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals.
• Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
• Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care.
• Assesses for medical necessity and authorizes all appropriate waiver services.
• Evaluates covered benefits and advises appropriately regarding funding sources.
• Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration.
• Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.
• Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns.
• Identifies critical incidents and develops prevention plans to assure member health and welfare.
• May provide consultation, resources and recommendations to peers as needed.
• Care manager RNs may be assigned complex member cases and medication regimens.
• Care manager RNs may conduct medication reconciliation as needed.
Required Qualifications
• At least 2 years experience in health care, including at least 1 year experience in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience working with persons with disabilities, chronic conditions, substance abuse disorders, and long-term services and supports (LTSS), or equivalent combination of relevant education and experience.
• Registered Nurse (RN). License must be active and unrestricted in state of practice.
• Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law.
• Ability to operate proactively and demonstrate detail-oriented work.
• Demonstrated knowledge of community resources.
• Ability to work within a variety of settings and adjust style as needed - working with diverse populations and various personalities and personal situations.
• Ability to work independently, with minimal supervision and demonstrate self-motivation.
• Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations.
• Ability to develop and maintain professional relationships.
• Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
• Excellent problem-solving and critical-thinking skills.
• Strong verbal and written communication skills.
• Microsoft Office suite/applicable software program(s) proficiency.
• In some states, must have at least one year of experience working directly with individuals with substance use disorders.
Preferred Qualifications
• Certified Case Manager (CCM).
• Experience working with populations that receive waiver services.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Residents enjoy outdoor activities, beautiful views, and a variety of community events that take advantage of the citys unique location La Porte is known for its exceptionally low cost of living, making it easier for residents to enjoy a comfortable lifestyle while staying within budget.
Housing costs, utilities, and everyday expenses are notably reasonable compared to neighboring urban centers Close to Houston Requirements: Board Eligibleor Certified Active Texasmedicallicense Managed or Value Based care experienced preferred but, not required.
Compass Healthcare Consulting & Placement is conducting a search for an Attorney, for an In-House Counsel opportunity for a Healthcare Group with an office located in Brooklyn, NY. Qualified candidates will have a Juris Doctor (JD) degree from an accredited law school and an active law license in New York State, required. Experience in Healthcare and Long Term Care Healthcare, preferred. This role involves advising the company on a wide range of legal matters specific to the healthcare and long-term care industry.
The In-House Counsel (Attorney) serves as an internal advisor to the company's executives and various departments and works with outside counsel on additional matters.
Responsibilities:
- Contract Management: Drafting, reviewing, and negotiating various contracts, including managed care and vendor agreements.
- Regulatory Compliance: Ensuring the organization complies with a complex web of federal and state healthcare laws and regulations.
- Risk Management: Identifying and assessing legal and business risks to help prevent future litigation.
- Litigation Oversight: Managing and coordinating the work of outside law firms when complex litigation is outsourced.
- Operational Support: Working closely with business teams on matters such as employment issues, real estate transactions, and mergers and acquisitions (M&A).
Qualifications and Requirements
- Education: A Juris Doctor (JD) degree from an ABA-accredited law school
- You must have a practicing law license and be in good standing with the bar association in NYS.
- 2-4 years of relevant legal experience, in a law firm or as in-house counsel, with a strong preference for a background in healthcare law, long-term care, or skilled nursing operations.
- Familiarity with healthcare-related legal issues, including regulatory compliance, contracts (e.g., commercial, employment, vendor), risk management, and potential litigation management.
- Exceptional negotiation, problem-solving, communication, and analytical skills are essential for managing legal risks and supporting business objectives.
Competitive Salary $300,000 - 350,000 plus benefits! Work Schedule 4 days in-office, 1 day remote.
Qualified Candidates Please Apply Now for Immediate Consideration!
Staff Actuary – Value Based Care
PRIMARY PURPOSE
Performance and maintenance of the monthly incurred but not reported (IBNR) healthcare claims process for a large risk based multi-specialty value-based care organization. Serve as a subject matter expert on IBNR estimates and payor data files. Investigate and analyze utilization and medical cost data in support of financial close, budget, and forecasting processes.
MAJOR RESPONSIBILITIES
- Create the monthly claim triangles, populate the IBNR models, and produce the IBNR estimates, working closely with accounting, finance, and operational leaders. Communicate results and supporting information to internal audiences including Finance, Accounting, and Value Based Care executives and team members. Maintain the IBNR models. Research issues and trends and keep leaders informed of findings. Update related monthly reports. Act as key contributor and subject matter expert during budget and forecast cycles. Interact with payor contacts and third-party actuaries as appropriate. (70%)
- Support the annual financial statement audit. Prepare lookback analyses and other information as requested by the auditor. Meet with the auditor as needed to answer questions. (5%)
- Perform medical expense projections and evaluate against payor contracts. (10%)
- Perform ad hoc analyses as requested by management. Independently surface insights and recommendations that help improve the accuracy of IBNR models and/or value-based care operations. (15%)
SUPERVISORY/MANAGEMENT SCOPE
- Role is viewed as a primary subject matter expert on all matters related to IBNR and will be looked to for advice, guidance, and mentorship.
- Manage entire IBNR process, on a monthly basis, to completion, meeting predetermined timelines.
MINIMUM EDUCATION AND EXPERIENCE REQUIRED
License / Registration / Certification
- Associate of the Society of Actuaries (ASA)
- Member of the American Academy of Actuaries (MAAA)
Level of Education
- BS or BA
Field of Study
- Actuarial Science, Mathematics, Statistics, Economics, or a related area
Years of Experience
- Minimum of five years of US healthcare actuarial work experience in managed care or closely related field, with at least 2 years estimating IBNR claims
Describe Type of Experience
- Experience supporting the monthly IBNR process (preferably 3+ years)
- Experience developing and maintaining complicated EXCEL/VBA models and presenting results (preferably 7+ years)
MINIMUM KNOWLEDGE, SKILLS, AND ABILITIES (KSA)
- Knowledge of IBNR methodologies and concepts
- Strong understanding of the US healthcare system
- Ability to work effectively with other team members, auditors, payor contacts, and third-party actuaries
- Ability to communicate complex concepts to technical and non-technical audiences
- Understanding of financial statements
- Understanding of relational databases
- Understanding of medical and pharmacy trends
- Understanding of medical claims coding and categorization
- Advanced knowledge of Excel
- Knowledge of SQL/Databricks
- Ability to write and edit VBA macros preferred
- Ability to identify and drill down into causes of changes in medical expenses
The compensation for this role includes a base pay range of $107K-$161K, with the actual pay determined by factors such as skills, experience, education, certifications, geographic location, and internal equity. Additional compensation may be available through shift differentials, bonuses, and other incentives. Base pay is only a portion of the total rewards package.
JOB DESCRIPTION Job Summary
Provides support for healthcare services clinical auditing activities. Performs audits for clinical functional areas in alignment with regulatory requirements - ensuring quality compliance and desired member outcomes. Contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties• Performs audits in utilization management, care management, member assessment, behavioral health, and/or other clinical teams, and monitors clinical staff for compliance with National Committee for Quality Assurance, Centers for Medicare and Medicaid Services (CMS), and state/federal guidelines and requirements. May also perform non-clinical system and process audits as needed.
• Audits for clinical gaps in care from a medical and/or behavioral health perspective to ensure member needs are being met.
• Assesses clinical staff regarding appropriate clinical decision-making.
• Reports monthly outcomes, identifies areas of re-training for staff, and communicates findings to leadership.
• Ensures auditing approaches follow a Molina standard in approach and tool use.
• Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA), and professionalism in all communications.
• Adheres to departmental standards, policies and protocols.
• Maintains detailed records of auditing results.
• Assists healthcare services training team with developing training materials or job aids as needed to address findings in audit results.
• Meets minimum production standards related to clinical auditing.
• May conduct staff trainings as needed. • Communicates with quality and/or healthcare services leadership regarding issues identified, and works collaboratively to subsequently resolve/correct.Required Qualifications
• At least 2 years health care experience, with at least 1 year experience in utilization management, care management, and/or managed care, or equivalent combination of relevant education and experience.
• Registered Nurse (RN). License must be active and restricted in state of practice.
• Strong attention to detail and organizational skills.
• Strong analytical and problem-solving skills.
• Ability to work in a cross-functional, professional environment.
• Ability to work on a team and independently.
• Excellent verbal and written communication skills.
• Microsoft Office suite/applicable software program(s) proficiency.Preferred Qualifications
• Utilization management, care management, behavioral health and/or long-term services and supports (LTSS) clinical review/auditing experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $33.4 - $65.13 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
* Outpatient only
* Active Fl license and DEA
* Board Certified Internal Medicine/ Family Medicine
* minimum of 3 years of managed care experience
* M-F 8:30-5
* Spanish-speaking is a plus
* EMR Greenway Health
* Excellent salary and full benefits package including Medical, dental, vision, 401K, and more
* Easy access to beautiful beaches, malls, and Universities
All-Star Recruiting Benefits
* Full-service agency
* 24/7 professional and reliable service
* Dedicated, specialty-specific consultants
* Board Certified Internal Medicine/ Family Medicine
* Managed Care experience preferred
* Spanish speaking preferred
* M-F 8-5
* no call
* EMR is ECW
* patient census is 16-18 patients per day
* Competitive Salary and Full benefits
* Easy access to Orlando and Tampa
All-Star Recruiting Benefits
* Full-service agency
* 24/7 professional and reliable service
* Dedicated, specialty-specific consultants
* Board Certified Internal Medicine/ Family Medicine
* Managed Care experience preferred
* Spanish Speaking preferred
* part-time
* no call
* EMR is ECW
* patient census is 16-18 patients per day
* Competitive Salary and Full benefits
* Easy access to Disney World, Universal Studios, and downtown Orlando
All-Star Recruiting Benefits
* Full-service agency
* 24/7 professional and reliable service
* Dedicated, specialty-specific consultants
* Outpatient only
* Active Fl license and DEA
* Board Certified Internal Medicine/ Family Medicine
* minimum of 3 years of managed care experience
* M-F 8:30-5
* Creole-speaking preferred but not required
* EMR Greenway Health
* Excellent salary and full benefits package including Medical, dental, vision, 401K, and more
* Easy access to beautiful beaches, malls, and Universities
All-Star Recruiting Benefits
* Full-service agency
* 24/7 professional and reliable service
* Dedicated, specialty-specific consultants
As Regional Medical Director, youll provide direct care in centers while mentoring new physicians, ensuring best-in-class clinical workflows, and partnering with operational leaders to shape strategy across multiple sites.This position blendspatient practice, leadership, and physician development" ideal for physicians with proven clinical excellence who are ready to take their career to the next level.Compensation & BenefitsCompetitive salary: $180,000"$285,000(based on experience)Sign-on bonus up to $75,000Annual merit increases + monthly/quarterly financial incentivesSubstantial PTO: 24 days + 5 CME days + 6 holidays annuallyFull benefits package, including:Malpractice coverage providedMedical / dental / vision / prescription insuranceLife & disability insurance401(k) with employer matchLicensure, certification, and membership reimbursementTuition reimbursement & CME allowanceAdditional perks: supplemental health benefits, FSA options, colleague discount program, identity theft services, relocation assistance (when applicable)Robust professional development: CME courses, leadership training, and future advancement opportunitiesKey ResponsibilitiesProvide direct patient care and set the standard for clinical excellenceMentor and guide physicians and APCs; lead onboarding and coaching efforts across centersCollaborate with Regional/Market Operations leadership on strategy, staffing, and quality initiativesDrive improvements in patient outcomes, client relationships, workflows, and case efficiencyContribute to market growth by strengthening payer, employer, and community partnershipsEnsure compliance with best practice guidelines, APC supervision standards, and safety protocolsHelp shape financial awareness and operational improvements across multiple sitesQualificationsMD or DO with active, unrestricted state licenseDEA license (or ability to obtain before start date)Board Certifiedin Family Medicine, Internal Medicine, or Occupational Medicine (required)At least 2 years relevant clinical experience; prior leadership or supervisory experience strongly preferredExperience in managed care or physician management a plusStrong communication, mentoring, and team leadership skills
* BC/BE in Internal Medicine or Family Medicine
* Must have experience in Managed care, Risk management, Medicare
* Census- 15-18 patients per day
* EMR-ECW
* M-F 9-5
* potential for growth into a Medical Director role
* Competitive Compensation and benefits package including, 401k, CME, yearly bonus and PTO
* Great location easy access to many major cities like Miami Beach, Fort Lauderdale, and the Florida Keys
All-Star Recruiting Benefits
* Full-service agency
* 24/7 professional and reliable service
* Dedicated, specialty-specific consultants
Optum NM is seeking a Palliative Care Physician to join our team in Albuquerque, New Mexico. Optum is a clinician-led care organization that is changing the way clinicians work and live.
As a member of the Optum Care Delivery team, you’ll be an integral part of our vision to make healthcare better for everyone.
At Optum, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you’ll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.
The Palliative Care Physician will manage high risk patients coming in and out of the hospital, or those with life-limiting illnesses. The physician will lead the team in high-risk patient care and the transition of care management. They will specialize in medical care that focuses on providing relief from pain and other symptoms related to chronic/serious illness. The aim is to provide comfort and improve quality of life for those suffering from chronic/serious illness. Palliative care is provided in tandem with regular treatment and in partnership with the patient’s primary care provider. The palliative program primarily manages care in the patient’s home; however, care may be appropriate or require in- office visits depending on the needs of the patient. Palliative Care requires a coordinated team approach, you must be able to have collaborative communication/interaction with other providers, nutritionists, social workers, nurses, etc.
In this position you will provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. You will enjoy working with our established team who are committed to delivering high quality care, adhere to ethical principles, and are sensitive to a diverse patient population.
Primary Responsibilities:
- Support the transition of care management for patients coming out of the hospital or skilled nursing facility. In collaboration with the team, direct and manage a complete continuum of quality-based care within the interdisciplinary team.
- Consult with patients to understand their health concerns and treat patients to provide relief from pain and other symptoms related to chronic/serious illness. Provide comfort and improve quality of life for those suffering from chronic/serious illness
- Consult and coordinate with patient’s primary care physician and other specialists as needed
About Albuquerque:
- 300 days a year of sun-drenched and picturesque mountain views
- Enjoy all seasons with mild winters
- A Top City with the Cleanest Air in America, Thrillist
- Top destination for hiking, biking, skiing and running
- Top 10 ranking for America’s Best Cities for Foodies, Travel + Leisure
- Diverse Culture - Art galleries, theater, concerts, shopping, music venues
- A Top Big Best Cities for Active Families, Outdoor Magazine
- Top 5 ranking for "Secretly Cool Cities”, Huffington Post
Compensation & Benefits Highlights
- Med/Den/Vis, STD, LTD, United Health stock options
- Continuing Medical Education allowance with time off
- Robust Relocation program
- Professional Liability Insurance
- Excellent PTO package
- Generous retirement program including employer funded contributions (401K)
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
- M.D. or D.O.
- Board Certified or Board Eligible in Internal Medicine or Family Medicine
- New Mexico Pharmacy/DEA Registration or ability to obtain
- Current MD/DO medical license in the state of New Mexico or ability to obtain
Preferred Qualifications:
- Palliative or equivalent experience in Geriatrics
- Experience in a managed care setting and working with medically complex patients
- Working knowledge of Medicare Advantage Risk plans
- Understanding of HEDIS measurements and delivering value-based care
Compensation for this specialty generally ranges from $229,50 to $378,000. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We comply with all minimum wage laws as applicable. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives.
OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
See additional details below.
LTSS Care Manager (RN) Highlights • The pay for this position is $36.21 – $65.09 per hour .
• Full-time schedule (standard weekday hours; may require field visits).
• Field-based position – candidates must reside in the Brooklyn or Bronx area to perform in-home UAS assessments.
• This position is a direct hire .
Responsibilities • Assess and coordinate medical and supportive services for complex or high-acuity members across the continuum of care.
• Conduct UAS assessments and evaluate service needs for long-term care members.
• Develop and maintain individualized care plans/service plans based on member needs and goals.
• Coordinate services between members, caregivers, healthcare providers, and community resources.
• Monitor member status, including changes in condition, complications, or clinical symptoms.
• Update care plans as needed to ensure members receive appropriate, person-centered care.
• Review referrals and intake assessments to determine appropriate care planning.
• Educate members and caregivers on disease processes, healthcare benefits, and care options.
• Serve as a liaison and advocate between members, families, physicians, and service providers.
• Coordinate service authorizations for supportive services such as transportation, meals, housing, and daily living support.
• Conduct home or site visits as required to assess needs and coordinate services.
• Document care management activities and maintain compliance with state, federal, and clinical guidelines.
• Collaborate with internal care management teams to improve care quality and service delivery.
Requirements • Graduate from an accredited school of nursing or Bachelor’s degree with 4–6 years of related healthcare experience .
• Bachelor’s degree in Nursing preferred.
• Active Registered Nurse (RN) license or Nurse Practitioner (NP) license in the state of New York.
• Experience in care management, long-term care, or managed care populations preferred.
• Ability to conduct field/home visits and community-based assessments .
• Strong documentation, coordination, and patient education skills.
Benefits Available • Benefits are available to full-time employees after 90 days of employment.
• A 401(k) with a company match is available for full-time employees with 1 year of service on our eligibility dates.
If you are interested in this LTSS Care Manager (RN) position, APPLY , or contact .
Establishing standards of nursing care for the unit Monitor nursing care center budgets Educate and develop unit nursing staff members Direct nursing/health care personnel, or a particular unit Manage and evaluate resident care and unit operations on assigned unit Supervise nursing care provided to residents Oversee an assigned nursing unit and support the nursing staff assigned to that unit through positive leadership Delegate responsibility to the nursing personnel on the unit for the direct nursing care of the residents Supervise and direct nursing/health care personnel, or a particular unit Maintain the standards of care for the unit Assure adequate staffing to provide nursing care Educate the nursing staff on patient care Develop care plan addressing immediate nursing problems Assume responsibility and accountability for the nursing care ofall residents on assigned unit Support nursing research and introduce new findings to the unit Maintain an ongoing quality assurance program for the nursing unit Assume responsibility and accountability for the nursing care of all residents on assigned unit Assume responsibility and accountability for the nursing care ofall residents on assigned unit Manage the unit's budget Evaluate all nursing procedures and systems relative to unit programming
Please check out the details below and apply immediately for a chance at working at this incredible group.
About the position: Type: Outpatient Primary Care / Managed Care / Geriatrics Clinic Hours: Mon-Fri 8am-5pm no weekends.
Locations: Mansfield, TX (30miles from Dallas) Ideal candidate: Board Certified or Board Eligible, Managed Care experience, and an active TX license.
Start date: Can start within 30-60 days Compensation: Negotiable based on the experience.
Includes a Salary + Performance bonus, which is paid quarterly.
Benefits: Full benefits If interested in learning more, please apply immediately and discuss with one of our recruiters.
