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Top Managed Care Executive

Directs organization's activities of strategic planning, evaluation, coordination, and implementation of various managed health care programs (HMO's, PPO's, long-term care). Organizes and develops short- and long-term planning programs to ascertain community and organization's requirements. Typically reports to Hospital Administrator and directs subordinate staff.: Administers fiscal operations such as budget planning and establishing rates for alternative delivery services. Directs activities concerned with contracts for alternate delivery systems. Reviews bids for conformity to contract requirements and determines acceptable bids. Negotiates contract with bidder. Requests or approves amendments to or extensions of contracts. Develops policies and procedures for various activities to assure objectives of hospital, managed care, physicians, care givers and patients are met. Ensures compliance of facilities with all regulations. Ensures that all providers and employees meet and maintain requirements and licenses. Develops and implements methods and procedures for monitoring work activities, such as preparation of records of expenditures, progress reports, etc., in order to inform management of current status of work activities. Recommends measures to improve methods, performance, and quality of service, and suggests changes in working conditions to increase efficiency. May recruit, hire, train staff, evaluate employee performance, and recommend or initiate promotions, transfers, and disciplinary action. Analyzes department budget to identify budget needs and or reductions, and may allocate operating budget's funds. Interprets company policy to employees and enforces safety regulations.

Managed Care Director

Develops and implements strategic, operational, and tactical business plans to meet customer service requirements and optimize financial performance. Maintains and develops relationships with health plans and medical groups. Develops contracting plans and forecasts. : Directs and performs the negotiation of contracts with managed care payers and group purchasing organizations. Monitors existing contract performance. Conducts financial analyses and considers impact of applicable regulatory requirements. Collaborates with senior management and/or multiple decision-makers to conclude sales. Serves as liaison between customer and company personnel on administrative matters. Develops and assists in implementation of referral strategies. Develops and manages the budget. Controls expenses while meeting operational, financial, and service requirements. Recruits, develops, and motivates staff. May lead team of sales/technical/marketing personnel on larger sales efforts.

Product Development Health Care Director

Directs and oversees the assessment and development of potential products and business service opportunities. Plans and directs all aspects of the organization's product development policies, objectives, and initiatives. Typically requires a college degree in health services or marketing and three years of related product development experience.: Conducts financial feasibility studies and directs market research of potential products and business service opportunities. Reviews and analyzes proposals submitted to determine if benefits derived and possible applications justify expenditures. Approves and submits proposals considered feasible to management for consideration and allocation of funds or allocates funds from department budget. Develops and implements methods and procedures for monitoring projects, such as preparation of records of expenditures and research findings, progress reports, and staff conferences, for management reporting. Researches new health care products, product enhancements, and product redesign that align the product development function with the goals of the organization. Evaluates the potential and practicality of products in development. Hires, trains and motivates a qualified staff. Prepares budgets and monitors expenditures. Prepares reports on progress and recommends the addition, expansion, or discontinuance of projects.

Hyperbaric Wound Care Technician

Provides safe and effective operation, control, and maintenance of Hyperbaric Chamber systems and supporting components. Administers hyperbaric oxygen therapy to patients as prescribed by Physician. Operates and maintains the hyperbaric chambers and associated systems and equipment. Typically requires basic EMT, respiratory therapy, or nursing assistant training. Certification from an approved hyperbaric course is typically required.: Assists in the delivery of patient care appropriate to level of medical training. Prepares the hyperbaric chamber, equipment, medicine, materials, and transports as needed for patients undergoing hyperbaric oxygen therapy. Observes the patients and the hyperbaric systems during the course of hyperbaric oxygen treatment. Reports unusual occurrences to Hyperbaric Physician and records patients' condition. Maintains the cleanliness of the hyperbaric oxygen therapy equipment and facility. Provides continuous patient contact, use of basic to moderate, related and some diverse body mechanics as well as intermittent exposure to occupational illness and hazards. Monitors patient's physiological responses to therapy, such as vital signs, arterial blood gases, and blood chemistry changes. Observes equipment function and adjusts equipment to obtain optimum results to therapy. Consults with Physician in event of adverse reactions. Maintains patient's chart that contains pertinent identification and therapy information. May accompany patients in the chamber while undergoing hyperbaric oxygen therapy, when deemed necessary by the Medical Director.

Home Care Hospice Reimbursement Manager

Assures that all daily patient financial services functions are completed to ensure maximum cash flow, timely customer service with patient families and other staff, and compliance with all regulatory requirements of governmental agencies and third party payers. Manages and supervises the Patient Financial Services staff.: Manages the production of the initial monthly billing, the monthly revenue journals, and related reports for General Accounting. Assists Contract Services in the development of rates for specific facility, provider, payer, and physician contracts. Assists the Controller and the Director of Accounting with revenue rate projections for annual budget preparation. Investigates and evaluates changes in any government or third party payer regulation that may impact reimbursement. Assists in the development of standards and processes that promote effective and efficient operations in the Patient Financial Services area and related areas. Oversees the coordination of staff to maintain the timely flow of billing data, including insurance verifications, census reporting, production of billing, and collections. Acts as an educational resource for staff and management for reimbursement, billing compliance, and insurance issues. Manages resources, such as time, expenses, supplies, labor, etc., and develops staff resources through training, mentoring, coaching, etc. May participate with various organizations on a local or State level in relationship to hospice/health care reimbursement.

Home Care Team Manager

Manages the clinical coordination of care for a team of home care providers. Directs patient services as related to the plan of care and utilization management in compliance with State and Federal regulations. Assist clinical staff in developing an appropriate plan of care. : Ensures timely and appropriate documentation on the patient record. Coordinates and initiates involvement of organization's resources, such as Advanced Practice Nurses, Home Health Aides, Therapists, Social Workers, Dieticians, etc. Makes home visits as necessary to assist or instruct Staff Nurses and to aid in effective case management. Ensures the proper use and ordering of supplies. Provides follow-up to patients and/or primary caregiver as necessary. Participates in quality improvement initiatives. Oversees scheduling of interdisciplinary team. Participates in intake processes as needed. Engages in proactive customer service with patient/family, referral sources, and colleagues. Maintains confidential patient and/or agency information in accordance to HIPAA and agency policies. Participates in the hiring, orientation, training, evaluation, and continuing education of staff assigned to the team. May act as a liaison with managed care companies in obtaining authorization.

Nurse Manager Acute Care Multiple Units

Manages and supervises staff for several acute care clinical units to include areas such as CCU, ICU, Psychiatric Unit, Burn, Operating Room, Recovery, Labor & Delivery or ER. Typically responsible for 7 days/week, 24 hours/day management. This position typically requires a registered nurse license and a minimum of five years of clinical nursing experience.: Manages and supervises staff for several acute care clinical units to include areas such as CCU, ICU, Psychiatric Unit, Burn, Operating Room, Recovery, Labor & Delivery or ER. Typically responsible for 7 days/week, 24 hours/day management. Assigns duties and coordinates nursing services and support personnel. Plans and supervises patient care. Evaluates nursing activities to ensure patient care, staff relations, and efficiency of service. Observes nursing care to ensure that treatments are administered in accordance with physician's instructions. Assists in establishing policies and procedures related to nursing functions. Directs preparation and maintenance of patients' clinical records. Inspects patient areas for cleanliness and comfort. Ensures that appropriate continuing education is maintained. Orders, or directs ordering of drugs, solutions, and equipment, and maintains records on narcotics. Investigates and resolves emergency and problem situations. Contributes to annual budget and monitors expenses. This position typically requires a registered nurse license and a minimum of five years of clinical nursing experience.

Nurse Manager Acute Care Unit

Manages and supervises staff for an acute care clinical unit to include areas such as CCU, ICU, Psychiatric Unit, Burn, Operating Room, Recovery, Labor & Delivery or ER. Typically responsible for 7 days/week, 24 hours/day management. This position typically requires a registered nurse license and a minimum of five years of clinical nursing experience.: Manages and supervises staff for an acute care clinical unit to include areas such as CCU, ICU, Psychiatric Unit, Burn, Operating Room, Recovery, Labor & Delivery or ER. Typically responsible for 7 days/week, 24 hours/day management. Assigns duties and coordinates nursing services and support personnel. Plans and supervises patient care. Evaluates nursing activities to ensure patient care, staff relations, and efficiency of service. Observes nursing care to ensure that treatments are administered in accordance with physician's instructions. Assists in establishing policies and procedures related to nursing functions. Directs preparation and maintenance of patients' clinical records. Inspects patient areas for cleanliness and comfort. Ensures that appropriate continuing education is maintained. Orders, or directs ordering of drugs, solutions, and equipment, and maintains records on narcotics. Investigates and resolves emergency and problem situations. Contributes to annual budget and monitors expenses. This position typically requires a registered nurse license and a minimum of five years of clinical nursing experience.

Adult Day Care Director

Oversees the daily operations of an Adult Day Care Center. Organizes and directs an adult care facility to provide supervision and continuing care to participants. Typically requires a bachelor's degree in a related field and five or more years of management experience in adult day care operations.: Ensures that the center meets all licensing regulations related to adult (elder) care centers. Manages day care billing and maintains account records. Collects and reconciles program tuition and collects monies for food service and deposits according to standard policies. Maintains relationships with families and develops programs responsive to family needs. Provides for ongoing safety of adults in daily center activities. Files accident reports, when necessary, and monitors adherence to established safety policies. Directs and supervises the work of staff in providing for the care and needs of the center participants. Develops, maintains, and implements policies and procedures. Confers and cooperates with management personnel in formulating administrative and operational policies and procedures. Reviews and analyzes expenditure, financial, and operations reports to determine requirements for the center's operations. Approves requisitions for equipment, materials, and supplies.

Managed Care Contracting Manager

Responsible for the coordination, evaluation and negotiation of managed care contracts under consideration. This position typically requires five or more years of experience in the negotiation of contracts in a managed care or hospital environment.: Responsible for the coordination, evaluation and negotiation of managed care contracts under consideration. Responsible for the oversight of all contract coordination activities. Represents the organization to the employer community and solicits business. Works with current subscribers to develop additional business opportunities. Coordinates contract negotiation and resolves complex issues. Works closely with physicians in program development and specialist relations. Monitors managed care contract performance and addresses related concerns. Evaluates potential business opportunities and develops innovative approaches that can benefit the organization. Attempts to standardize contracts to ensure effective and efficient implementation. This position typically requires five or more years of experience in the negotiation of contracts in a managed care or hospital environment.



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