Newquest LLC

  • United States
Newquest LLC Remote * (Bloomfield, CT, USA)
Sep 18, 2021
Remote, work from home - East, Northeast and MidAmerica (must be located in/or near area) SUMMARY: This position serves as an integral member of the Medicare Provider Contracting Team and reports to the Provider Contracting Director. This role is a key contributor to the development of the strategic direction and is accountable for the management of contracting and network management activities in states across the Northeast. Ideal candidate: Medicare Advantage, Value-Based and/or Risk Sharing Contracting Experience. RESPONSIBILITIES: Manages increasingly complex contracts and negotiations for fee for service and sophisticated value-based reimbursements with hospitals and other providers (e.g., Hospital systems, Ancillaries, and large physician groups) for one or more geographies. Proactively builds relationships that nurture provider partnerships and seeks broader value-based business opportunities to support the local market strategy. Initiates, nurtures and...
Newquest LLC Remote * (United States)
Sep 16, 2021
Position Summary : Responsible for collaborating with healthcare providers, members, and business partners, to optimize member benefits, evaluate medical necessity and promote effective use of resources. Medical necessity reviews may include: inpatient admissions, outpatient services, surgical and diagnostic procedures, home health, durable medical equipment and out of network services. Conduct reviews in compliance with medical policy, member eligibility, benefits, and contracts. Essential Duties and Responsibilities: Responsible for the effective and sufficient support of all Utilization Management activities to include review of inpatient and outpatient medical services for medical necessity and appropriateness of setting according to established policies and compliance guidelines. Uses an established set of criteria to evaluates and authorize the medical necessity of services. Provide notification of decisions in accordance with compliance guidelines. Coordinate with...