- The Cigna Group (Columbus, OH)
- **WORK LOCATION: Cleveland or Independence, OH area.** The ** Provider Contracting Director** serves as an integral member of the Provider Contracting ... Team and reports to the Provider Contracting Senior Manager. This role assists in developing the...cost and quality. + Drives change with external provider partners by assessing clinical informatics and offering consultative… more
- CVS Health (Columbus, OH)
- …issues. **Required Qualifications** + A minimum of 3 years work experience in a provider contracting or provider relations role, Medicaid and/or behavioral ... and exceeding accessibility, compliance, quality, and financial goals and cost initiatives. Collaborates cross-functionally to develop provider compensation… more
- Molina Healthcare (Columbus, OH)
- …previous experience in contracting with large specialty or multispecialty provider groups. * 1-3 Years Managed Care experience **PREFERRED EXPERIENCE** ... **Job Summary** Molina Health Plan Provider Network Contracting jobs are responsible...with VBC providers that result in high quality and cost -effective care . Maintains tracking system and publishes… more
- Molina Healthcare (Columbus, OH)
- …customer service, provider service, or claims experience in a managed care setting. + Working familiarity with various managed healthcare provider ... negotiating different provider contract types, ie, physician, group and hospital contracting , etc. To all current Molina employees: If you are interested in… more
- Western Digital (Columbus, OH)
- …supplier performance, resolve issues, and drive improvements in quality, delivery, and cost . + **Negotiation and Contracting :** Lead negotiations with suppliers ... Manages compliance to contracting terms and proactively develops and manages contracting metrics + ** Cost Optimization:** Drive cost -saving initiatives… more
- Highmark Health (Columbus, OH)
- …Consulting or related area + 3 years Value-based reimbursement, through managed care contracting , provider reimbursement, consulting, population health ... a focus of innovation. + Develop and maintains strategic provider relationships to understand the current health care...projects + 5 years Familiarity with health plan and provider contracting or revenue management + 2… more
- Prime Therapeutics (Columbus, OH)
- …(PBM), healthcare or other highly regulated industry; including 5 years of managed care experience in medical or pharmacy network contracting Must be eligible ... specialty, and quality-based networks aligning with Prime's Supply Chain Cost of Goods Sold (COGS) and network management strategies....different kind of PBM. We're reimagining pharmacy solutions to provide the care we would want for… more
- Oracle (Columbus, OH)
- …time estimates. + Gather, analyze, and document LOE data to prepare accurate project cost estimates for contracting purposes. + ** Contracting & Budgeting:** ... them turn data into lifesaving decisions and better patient care . We want people just as dedicated as we...the capture of the level of effort (LOE) for contracting work. This role will be essential in bridging… more
- Oracle (Columbus, OH)
- …clear roles, SLAs, and succession plans. + Chair the Estimate Review Board; provide independent cost assurance for major funding decisions. + Oversee development ... change orders for reasonableness. + Support negotiations with LV and other contractors; provide claim analysis and cost entitlement assessments. + Maintain a… more
- Molina Healthcare (Columbus, OH)
- …health plans on the financial impact. * Work independently to support and validate Provider Network contracting and unit cost management activities through ... problematic contracts. Supports multi-dimensional pricing strategies to drive down total cost of care and minimize variation in cost by leveraging… more
- Molina Healthcare (Columbus, OH)
- …health plans on the financial impact. + Work independently to support and validate Provider Network contracting and unit cost management activities through ... problematic contracts. Supports multi-dimensional pricing strategies to drive down total cost of care and minimize variation in cost by leveraging… more
- Oracle (Columbus, OH)
- …to market by managing pipeline intake and ensuring seamless engagement during contracting and estimating of Non-Recurring Costs (NRCs) with lease providers. This ... with precision and urgency. As a manager, you will provide strategic and operational leadership for a team of...maintain intake processes that balance speed with rigor. + ** Contracting & NRC Estimation** + Lead engagement with lease… more
- Molina Healthcare (Columbus, OH)
- …management standardization, and cost -effective quality outcomes in a managed care environment. Contributes to overarching strategy to provide quality and ... for multi-state licensure. 5+ years in behavioral health-specific managed care leadership. + Experience with value-based contracting , fraud/waste/abuse… more
- Molina Healthcare (Columbus, OH)
- …senior level clinicians and leaders from functional areas such as finance, health care services and provider contracting to translate analytic observations ... in medical coding/billing (UB04/1500 form). * Advanced understanding of key managed care concepts and provider reimbursement principles such as risk adjustment,… more
- CDM Smith (Columbus, OH)
- … cost estimates and supporting analysis in coordination with government cost estimators and contracting officers. * Participate in pre-construction meetings, ... and prepares technical reports and/or project status reports. * Provide engineering judgment for field modifications, non-conformance issues, value engineering… more
- Prime Therapeutics (Columbus, OH)
- …address changing market demands and ensure Prime is delivering the highest quality and lowest cost of care to its members and related client messaging as well as ... pipeline to capitalize on savings through effective negotiation and contracting + Develop strong working relationships and communication at...different kind of PBM. We're reimagining pharmacy solutions to provide the care we would want for… more
- OhioHealth (Columbus, OH)
- …a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach further to help people uncover their own power to be ... etc.). Ensures privacy and security of information entrusted to their care . Uses company business assets and information resources for management-approved purposes… more
- Molina Healthcare (Columbus, OH)
- …interpolation and other statistical methodologies to predict future trends in cost , utilization and performance. Provide executive summary of findings ... of businesses. + Analysis and reporting related to Managed care data like Medical Claims, Pharmacy, Lab and related...and related financial data like risk score, revenue and cost . + Conduct root cause analysis for business data… more
- Oracle (Columbus, OH)
- …largest health systems-helping them turn data into lifesaving decisions and better patient care . We want people just as dedicated as we are making history with ... ideal candidate will have a solid understanding of federal contracting rules and regulations and be comfortable operating within...and impact of thematic risks across scope, schedule, and cost . + **Risk Management.** Manage a portfolio of risks… more
- Oracle (Columbus, OH)
- …types, and storage tiers to balance performance, HA, Business Continuity, and cost in hyperscaler environments + **Structured Data** : Oracle Database, NoSQL, MySQL, ... **Responsibilities** **Key Responsibilities** As an individual contributor, this role will provide leadership across the CSS organization and throughout Oracle by… more