- Prime Healthcare (Ontario, CA)
- …team! Responsibilities This position requires relocating to Ontario, California. TheVice President of Health Plan Operations and Claims is responsible for ... across all aspects of the Employee Health Plans. The VP of Health Plan Operations and Claims will provide strategic leadership and development of the… more
- McLaren Health Care (Flint, MI)
- McLaren Health Plan (MHP) is a company with a culture of high performance and a mission to help people live healthier and more satisfying lives. We are looking ... and Medicare plans to Michigan residents for every stage of life. McLaren Health Plan is accredited by the National Committee for Quality Assurance (NCQA). MHP… more
- Henry Ford Health System (Traverse City, MI)
- …Minimum of three (3) years of leadership and/or management experience. + Familiarity with health plan operations and federal and state regulations. + ... to provide expertise, knowledge and recommendations for seamless daily operations . Bring concerns and pending issues to the Director...Familiarity with a broad range of health plan options (HMO, PPO, CDHP). CERTIFICATIONS/LICENSURES… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …transformation, technology implementations, or operational redesign programs + Deep understanding of health plan operations including benefits design, claims ... our academic community. **Description** **Architect the Future of Healthcare Delivery** Emory Health Plan seeks a visionary transformation leader to orchestrate… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …fiscal discipline + Lead annual budgeting, forecasting, and scenario planning for $1.3B health plan operations + Serve as principal financial advisor ... of our academic community. **Description** **Transform Healthcare Finance at Scale** Emory Health Plan seeks an exceptional finance leader to architect and… more
- UPMC (Pittsburgh, PA)
- …of the time. + Work that matters-your contributions will directly impact patient care and health plan operations . + Opportunities to grow your technical and ... with Azure tool. + Knowledge of pharmacy and/or care management within a health plan . + Understanding of enrollment processes at a payer organization. Why You'll… more
- Two95 International Inc. (Atlanta, GA)
- … Care Management, Computer Science, or related field * 10+ years of experience in health plan operations including but not limited to enrollment, finance, ... Job Title: Director, Health Plan Analytics Job type : Remote Work Type : 6+ Months Contract with extension Rate : $Market /Hour Requirements Position Summary: As… more
- Northwell Health (New York, NY)
- **Req Number** 173504 Job Description The AVP for Health Plan Performance will be responsible for driving the performance of our network solution across ... coordination and administration of policies, services and programs that optimize health plan performance for Northwell Direct. Collaborates with leadership… more
- CVS Health (Hartford, CT)
- …manage, and resolve escalated and complex global issues for Claims/Calls, PSS, and health plan back-office operations . The PSL role has responsibility ... manage, and resolve escalated and complex global issues for Claims/Calls, PSS, and health plan back-office operations . The Plan Sponsor Liaisons serve as… more
- TEKsystems (Martinez, CA)
- …Knowledge, Skills, and Abilities Knowledge of: Principles of healthcare administration and health plan operations Principles of leadership, management, ... and COO to assist in future planning for the Health Plan Skills Supervision, Support, Epic Top...our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions.… more
- CareFirst (Washington, DC)
- …strategy to execution. This position will report to CareFirst BlueCross BlueShield Community Health Plan - Chief External Operations Officer. **ESSENTIAL ... market expansion + Lead day-to-day operations of the Healthy DC Plan Basic Health Plan in DC. + Develop and oversee day-to-day operations for… more
- Sea Mar Community Health Centers (Seattle, WA)
- …designation of priority objectives for the Home Health Division. + Develop the Home Health plan for clinical operations and provide for efficient use of ... community. Essential Duties and Responsibilities: + Planning: + Develop the Home Health Division plan for clinical operations and provide for efficient use… more
- Highmark Health (Oklahoma City, OK)
- …and Provider support teams, Actuary, Finance, Highmark Health Solutions, Health Plan Operations . **ESSENTIAL RESPONSIBILITIES** + Perform management ... business. This will require aligning new models to the health plan 's strategic objectives based on a...Plan , organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and… more
- Point32Health (Canton, MA)
- …strong consultative skills. + Working knowledge of both the medical and business side of health plan and provider operations . + Ability to understand and ... members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan...**Job Summary** This position will lead the Risk Adjustment Operations & Provider Consulting team responsible for the department's… more
- CVS Health (Chicago, IL)
- … insurance experience preferred). + Experience in business consulting, customer experience or health plan operations . + Ability to synthesize information ... At CVS Health , we're building a world of health...synthesis of customer feedback across multiple sources, such as plan sponsors, members, sales and service teams, brokers and… more
- Highmark Health (Pittsburgh, PA)
- … Network and other affiliated Health Systems, Product & Healthcare Services, Health Plan Operations , Actuarial Services, and Government and Commercial ... educate and engage broker community; support continued development and refinement of health plan 's distribution strategy, utilizing an internal matrixed network… more
- UCLA Health (Los Angeles, CA)
- …degree, preferred + Eight or more years in managed care, Medicare Advantage, or health plan operations , including vendor and supplemental benefit management ... the vendor lifecycle + Partner cross-functionally with internal teams (eg, Operations , Compliance, Finance, Product, and Clinical) to ensure accurate benefit… more
- Health Care Service Corporation (Richardson, TX)
- …and ensure ROI. **PREFERRED JOB REQUIREMENTS** **:** + Knowledge of Medicaid and/or Medicare health plan and PBM operations . + Additional degrees or ... This position is responsible for directing the Medicaid pharmacy operations team and responsible for analyzing and optimizing the...employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan ,… more
- AmeriHealth Caritas (Manchester, NH)
- …+ Demonstrated knowledge and experience in a leadership role in corporate or health plan operations including enrollment, member services, provider ... essential. The Market President will lead the effective and efficient operations of this Health Plan directly and/or indirectly overseeing Medical Affairs,… more
- Commonwealth Care Alliance (Boston, MA)
- … operations and satisfaction. * Strong understanding of Medicare and Medicaid health plan operations , including regulatory and compliance requirements. * ... or healthcare operations within a managed care organization, health plan , or integrated delivery system. * Demonstrated success building and managing… more
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