Managed Care Contractor
$99.84k - $164.74kLurie Children's
- # Managed Care ContractorApplylocations: Streeterville, Chicago, ILtime type: Full timeposted on: Posted Todayjob requisition id: JR2026-519Ann & Robert H. Lurie Children’s Hospital of Chicago provides superior pediatric care in a setting that offers the latest benefits and innovations in medical technology, research and family-friendly design. As the largest pediatric provider in the region with a 140-year legacy of excellence, kids and their families are at the center of all we do. Ann & Robert H. Lurie Children’s Hospital of Chicago is ranked in all 10 specialties by the U.S. News & World Report.**Location**680 Lake Shore Drive**Job Description**Reports to the Director of Managed Care Contracting. Core responsibilities are the negotiation of Single Case Agreements (SCA) for Transplants, General/Surgical Medicine, as well as hospital ancillary agreements. Contractor shall assist/lead transplant contract negotiations, validate profit/loss values by Payor, as well as assist Transplant Team in completion of Report for Information (RFI) requirements/requests. Another key focus of this position will be negotiating/managing/tracking all requests for single case agreements for Out of State Medicaid (OOS) and non-contracted HMO payers. Secondary responsibility is to assist Director of Managed Care Contracting with tracking/evaluating SCAs and Transplant Agreements, monitor outcome & contract performance, validation of accurate and timely billing/reimbursement per SCA/other contract. Establish a process for monitoring timelines and contract terms to eliminate retrospective requests for SCA with non-contracted payers. Assist Director of Managed Care Contracting with Commercial payers, Marketplace Exchange and IPA/PHO/CIN groups.**Essential Job Functions:*** Oversight and control of factors creating financial loss and liability related to OOS Medicaid and non-contracted HMO members seeking access to care.* Become the primary and immediate contact point for all Lurie Children’s employees regarding OOS Medicaid and non-contracted HMO members seeking or receiving access to care within the Lurie Children’s facility. Provide education/in-services on OON process as needed Validate that accurate & complete information is provided during the OON Process* Serve as the main contact for Payor negotiations with OOS Medicaid payors, non-contracted HMOs and Marketplace Payors.* Develop a data base of historical, out of state Medicaid transplant events/encounters: States, payor names, challenges (Credentialing, numbers of LOAs needed for single admissions, trackable payments due against actual received, etc.)* Assist in negotiating contracts for HMO IPA groups and other entities/specialties as requested by Leadership (behavioral health, surgical centers, therapy centers, etc.)Collaborate with Patient Financial Services (PFS) to: Work directly with designated PFS representative to maintain on going reports for AR with the IPAs Work directly with designated PFS representative developing a checklist that creates efficiencies in tracking all aspects of transplant billing/collection as well as specific, individual contract terms that may be required by individual Payors.* Information Development: Serve as the collection point of all information related to OOS Medicaid and non-contracted HMO cases: demographics, reimbursement terms, prompt billing & payment timelines, problems per case/state; prepare report with summary information as needed by Leadership* Review inpatient report daily to identify unplanned OOS Medicaid patients & education needed by Divisions/teams re: OON process for follow up Help identify areas in need of assistance to ensure that OOS Medicaid and non-contracted HMO cases are identified appropriately* Identify and investigate OOS Medicaid and non-contracted HMO cases:* Establish/manage positive partnering relations with all internal and external partners.* Coordinate with PFS/Transplant billers to assist in evaluation of performance (profit/loss) of transplant contracts aggregated at program level* Develop Actual vs Expected reporting to monitor Transplant contract performance* Participate with PFS to identify any potential errors/contract compliance in transplant billing per contract/LOA* In conjunction with Managed Care Operations, perform analysis to establish targeted reimbursement levels in all agreements.* Participate/engage in Commercial/Medicaid payor meetings* Participate in internal meetings as appropriate including but not limited to Medical Management meetings, denial meetings, etc.* Become and remain on an ongoing basis, knowledgeable on the “No Surprise Billing Act” including revisions and amendments* Assist in investigating Financial Council cases for annual report* Assist in tracking Financial Council cases for concurrent monitoring against Financial Council budget in real time* Reasonably assist Case Management team with appeals based on contract terms.* Other responsibilities as assigned.**Additional Responsibilities**Position entails leading, assigning work to others, and frequent follow-up.**Knowledge, Skills and Abilities:*** A Bachelor’s degree is required. Masters Degree preferred.* Nursing Background is a plus.* Knowledge of EPIC is a plus.* 5 years of healthcare experience in managed care negotiations (Payor or provider) preferred.* Transplant experience and familiarity required.* Strong analytical ability is required* High level of communication skills**Education**Bachelor's Degree (Required)**Pay Range**$99,840.00-$164,736.00 SalaryAt Lurie Children’s, we are committed to competitive and fair compensation aligned with market rates and internal equity, reflecting individual contributions, experience, and expertise. The pay range for this job indicates minimum and maximum targets for the position. Ranges are regularly reviewed to stay aligned with market conditions. In addition to base salary, Lurie Children’s offer a comprehensive rewards package that may include differentials for some hourly employees, leadership incentives for select roles, health and retirement benefits, and wellbeing programs. For more details on other compensation, consult your recruiter or click the following link to learn more about our benefits.**Benefit Statement** **For full time and part time employees who work 20 or more hours per week we offer a generous benefits package that includes:**Medical, dental and vision insuranceEmployer paid group term life and disabilityEmployer contribution toward Health Savings AccountFlexible Spending AccountsPaid Time Off (PTO), Paid Holidays and Paid Parental Leave403(b) with a 5% employer match Various voluntary benefits:* Supplemental Life, AD&D and Disability* Critical Illness, Accident and Hospital Indemnity coverage* Tuition assistance* Student loan servicing and support* Adoption benefits* Backup Childcare and Eldercare* Employee Assistance Program, and other specialized behavioral health services and resources for employees and family members* Discount on services at Lurie Children’s facilities* Discount purchasing program **There’s a Place for You with Us** At Ann & Robert H. Lurie Children’s Hospital of Chicago and its affiliates (collectively “Lurie Children’s”), we embrace and celebrate diversity and equity in a serious way. We are committed to building a team with a variety of backgrounds, skills, and viewpoints — recognizing that diverse identities strengthen our workplace and the care we can provide to the Chicago community and beyond. We treat everyone fairly, appreciate differences, and make meaningful connections that foster belonging and allyship. This is a place where you can be your best, so we can give our best to the patients and families who trust us with their care. Lurie Children’s and its affiliates are equal employment opportunity employers. We value diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity or expression, religion, national origin, ancestry, age, disability, marital status, pregnancy, protected veteran status, order of protection status, protected genetic information, or any other characteristic protected by law. For questions about how to request an accommodation please contact: View email address on click.appcast.io **AI Notice** Lurie Children’s utilizes certain AI-enabled features within our recruiting platform to support candidate engagement and assist recruiters in identifying and prioritizing applicants whose experience aligns with job requirements. All employment decisions are made by individuals. It is a civil rights violation with respect to recruitment, hiring, promotion, or employment for an employer to use artificial intelligence that has the effect of subjecting employees to discrimination on the basis of protected classes under the Illinois Human Rights Act or to use zip codes as a proxy for protected classes. For questions about the use of artificial intelligence in this process or any additional support, please contact: View email address on click.appcast.io
- J-18808-Ljbffr Lurie Children's
Vacancy posted 1 day ago
Similar jobs that could be interesting for youBased on the Managed Care Contractor in Brooklyn, NY vacancy
$52k - $55k
...authorizations, and payments between the agency stakeholders (youth, parents, contractors, physical and behavioral health providers, agency administrators, Board of Trustees) and Managed Care Organizations (MCOs) to ensure the needs of individual children are appropriately...For contractorsFull timeTemporary workImmediate startMercyFirst
Brooklyn, NY5 days ago$25 - $27 per hour
...About Elite Elite Home Health Care is a licensed home care agency that provides professional... ...patients. You will be responsible for managing an assigned caseload, strategically... ...and handle calls, emails, or faxes from contractors and clients requesting information or...For contractorsWork experience placementWork at officeFlexible hoursElite Home Health Care
Brooklyn, NY4 days ago- ...caseload of moderately difficult cases; manages a caseload of increasingly difficult cases... ...for all agency employees and contractors that have access to federal tax information... ...physical), exercising the right to family care and medical leave, gender, gender expression...For contractorsFull timeTraineeshipWork at officeLocal area
County Of Plumas
Brooklyn, NY2 days ago - Lurie Children’s Hospital seeks a Managed Care Contractor to negotiate SCAs for transplants and general hospital services, including Out of State Medicaid and non-contracted HMOs. You will support the transplant team, validate billing terms, and manage timelines for complex...For contractorsContract work
- ...Practitioner (NP) – Nursing Home Primary Care (Weekend Coverage)A medical group providing... ...home environment. The provider will manage patient visits, follow-ups, and coordinate... ....• $500 – $600 per day• 1099 independent contractor• Additional earning potential depending on...For contractors
Med Staff Group
Brooklyn, NY1 day ago - ...repairs to preserve property value and resident satisfaction. Responsibilities include managing work orders, monitoring the maintenance budget, supervising staff, performing preventive maintenance, and coordinating with contractors. #J-18808-Ljbffr Beacon Communities LLCFor contractors
- ...reliable Facilities Associate to assist with daily operations and the security and care of the facility. The role includes opening the building, coordinating with contractors, managing deliveries, and supporting events and safety procedures. The position is full-time with...For contractorsFull timeEarly shift
- ...Director# Maintenance DirectorEast Park Care Community - Brookpark, OH 44142## OverviewSalary... ...standards. The Maintenance Director manages a team of maintenance staff, oversees... ...appropriate tools and equipment.* **Vendor and Contractor Management:** + Coordinate with outside...For contractorsLocal area
East Park
Brooklyn, NY5 days ago - ...take pride in tackling complex work with care and integrity. At Lightpath, every role... ...engineered to last. Position Summary The Project Manager – OSP Construction is responsible for... ..., Supply Chain, Finance, and external contractors to ensure projects are completed safely,...For contractorsWork at officeLocal areaRemote work
Lightpath
Brooklyn, NY1 day ago $28 per hour
...rewarding. Purpose of this Position The Manager of Operations (Manager) provides daily operation... ...Operations and non-university contractors/vendors to ensure the proper maintenance... ...offers a wide range of benefits designed to care for the whole person. Choose from three...For contractorsHourly payContract workTemporary workImmediate startFlexible hoursAfternoon shift- ...about our work and committed to taking care of our customers, our employees, and our... ...JANSON team. Position Summary The Project Manager is responsible for the day-to-day... ...between the client, design team, consultants, contractors, vendors, field staff, and internal...For contractorsTemporary work
$60k - $63k
...here lives out our mission to **C.A.R.E. (Care, Achieve, Respect, Educate)**. If you're... ...equipment* Ensure outside vendors and contractors complete work according to contracts and... ..., coaching, scheduling, and performance management* Department accountability for maintenance...For contractorsFull timePACS Group
Brooklyn, NY1 day ago- ...discovered something special. A company that cares. Cares about leading the way in... ...our Culture of Care.The Senior Project Manager is responsible for generating business,... ...with crew, customers, foreman, and general contractors to ensure proper job progress and to support...For contractorsFull timeWork at officeMonday to FridayFlexible hours
Faith Technologies
Staten Island, NY1 day ago $32 - $38 per hour
...Job Title: House Manager & Family Assistant (with Backup Childcare & Pet Support) Location... ...errands, you approach each task with care, enthusiasm, and flexibility. A strong communicator... ...(e.g., handymen, cleaners, landscapers, contractor) Maintain indoor plants Inventory...For contractorsPart timeSeasonal workImmediate startNight shift2 days per week3 days per weekWeekday workSage Haus
Brooklyn, NYmore than 2 months ago- At Knife River, we take care of our team because we know it’s our people who make us... ...largest construction materials producers/contractors in the Country, and we are a PEOPLE-first... ...an experienced Construction Operations Manager to lead and oversee all construction operations...For contractorsFor subcontractorWork at officeFlexible hoursNight shift
- ...annual sales that delivers extraordinary care to help individuals and businesses... ...underwriting philosophy, mortality and risk management, reinsurance considerations, audit expectations... ...utilization of third-party services and contractors, fosters the accelerated underwriting...For contractorsWork at officeRemote workFlexible hours
$23.51 - $34.03 per hour
## Care Mgmt CoordinatorApplylocations: Home Office - Californiatime type: Full timeposted... ...we serve.**The Job**The Care Management Coordinator - ICD is responsible for coordinating... .../Individuals with Disabilities***The contractor will not discharge or in any other manner...For contractorsHourly payRemote workHome office- ...apply online.**Job Summary**Responsible for managing and completing the operations scope of a... ...readiness between Vistra and the Contractors.·Direct and approve Operations reviews,... ...work as a team, we compete to win, and we care about our stakeholders, including our customers...For contractorsContract workLocal areaShift work
$40.45 - $62.7 per hour
...experience, among other factors. Position Highlights Position: RN Care Manager Location: Chicago, IL Part Time: 20 hours per week Hours: 2 1... .../Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor. Welcome to Endeavor Health Careers At Endeavor Health, we...For contractorsHourly payFull timePart timeShift workWeekend work$25 - $28 per hour
Job Title: House Manager & Family Assistant (with Childcare Support) Location: East Nashville... ...prep to vendor coordination is taken care of with efficiency and care. Who You Are... ...like cleaners, landscapers, and contractors to keep things in tip-top shape. Oversee...For contractorsFull timeSeasonal workImmediate startFlexible hoursAfternoon shift2 days per week- ...# Ensure all incidents are reported, managed and reviewed according to New York State... ...situations are to enhance the quality of care provided to persons with developmental disabilities... ..., interns, volunteers, consultants, contractors, and family care providers. # Advise...For contractorsWork experience placementWork at officeImmediate start
EIHAB
Springfield Gardens, NY25 days ago $105k - $110k
...we are dedicated to transforming patient care by providing innovative and efficient... ...dispensing solutions streamline medication management, improve patient outcomes, and enhance... ...operations, facilities teams, architects, contractors, technology vendors, and regulatory...For contractorsRemote workRelocationAfternoon shift- Registered Nurse Case Manager (RN) - Workers' Compensation 1099 Independent Contractor | South Florida | Flexible, Field-Based Role About The IMA Group The IMA Group... ...legal teams Evaluate medical necessity and quality of care Draft clear, timely case management documentation...For contractorsLocal areaRemote workFlexible hoursShift workWeekend work
- PIH JOB DESCRIPTION (OPERATIONS MANAGER) Position Title: Operations Manager Reports to: Deputy... ...the Infrastructure Coordinator during contractor project briefing and internal policies... ...otherwise have access to quality health care. PIH partners with the world’s leading academic...For contractorsFixed term contractWork at officeLocal area
$51.9k - $87.9k
...to moderately complex client challenges. Manage portfolio priorities based on client needs... ...system performance, and deliver better care. Headquartered in Irving, Texas, with 11... ...continuum of care: Apexus - The exclusive contractor for 340B Drug Pricing Program, managed by...For contractorsContract workVizient
Brooklyn, NY1 day ago$77.59k - $110.44k
...Participant Support Specialist Primary Case Manager 1. FTE 8hr position 8 days ago... ...connects hundreds of participants to primary care, prevents overdoses (no participant has... ...Collaborate with staff, participants, and contractors to build a positive, productive, and...For contractorsPermanent employmentTemporary workTraineeshipRelocationFlexible hoursShift work$107.1k - $160.7k
...always design with community in mind. We care about the communities we serve—because... ...designers, engineers, scientists, and project managers, innovating together at the intersection... ...gas, and indoor air Overseeing field contractors (drillers, etc.) and field staff...For contractorsWorldwide$90k - $95k
...create a Black feminist future rooted in care, equity, community safety, and... ...change. The Healing to Advocacy Program Manager is a crucial leader within our organization... ...implementation; bring out the best in staff, contractors, and members through strong management and...For contractorsFull timeShift work- ...service. We aim to deliver high-quality care in a way that upholds the health of our... ...requirement to provide Non Clinical Case Management Services for VTARNG service members (SM)... ...outside of VTARNG facilities Schedule The contractor shall provide services between the hours...For contractorsContract workWork experience placementWork at officeMonday to FridayWeekend work
$70 per hour
...Health | Flexible Schedule Concierge Home Care | Orange Park, FL 32073 PRN | Flexible... ...Home Care Flexibility & Autonomy Create and manage your own schedule No weekends or holidays... ...Flexible employment options: PRN or 1099 contractor Mileage reimbursement Employee referral...For contractorsFull timeReliefFlexible hoursShift workWeekday work
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Managed Care Contractor. Be the first to apply!
Related searches
- network contractor Brooklyn, NY
- government contractor Brooklyn, NY
- contractor Brooklyn, NY
- military contractor Brooklyn, NY
- mail contractor Brooklyn, NY
- independent contractor driver Brooklyn, NY
- driver delivery independent contractor cargo van Brooklyn, NY
- federal contractor Brooklyn, NY
- independent contractor part time Brooklyn, NY
- truck contractor Brooklyn, NY