- CVS Health (King Of Prussia, PA)
- …plan design, contract language, service, claims or compensation issues, and provider education needs. + Optimizes interactions with assigned providers and internal ... limited to, claims payment, contract interpretation or parameters, and accuracy of provider contract or demographic information are resolved. + Supports or assists… more
- CVS Health (Princeton, NJ)
- …more personal, convenient and affordable. **Position Summary** The Behavioral Health Senior Manager of Network Relations is a key role on the Aetna Better Health ... Network . The Behavioral Health Senior Manager of Network Relations will report to the Executive... provider services requirements under this Agreement + Provide provider education and develop and deliver… more
- Humana (Columbus, OH)
- …Bachelor's degree + 5+ years of experience in network development, contracting, and/or network management or provider relations experience. + 2+ years of ... community and help us put health first** The Advisor, Medicaid Network Strategy will be accountable for...subject matter expert to assist business development in developing provider network request for proposal (RFP) responses.… more
- CVS Health (Trenton, NJ)
- …internal provider relations representatives to ensure successful Provider Relationships, and Network Performance including Clinical and Affordability ... others at all levels + Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and … more
- Humana (Indianapolis, IN)
- …2+ years of health care or managed care experience working with providers (eg, provider relations , claims education). + Experience working with LTSS and HCBS ... ensure positive provider experience with Humana Healthy Horizons and promote network retention. Key roles and responsibilities: + Meets regularly, both in person… more
- WellSense (Boston, MA)
- …and experience **Experience:** + 4 or more year's progressively responsible experience in provider relations or network management required + Experience in ... Sr. Provider Relations Consultant- (MA residents)-$5000 sign...and promoting collaboration within Plan, as it relates to provider network maintenance. Manages territory inclusive of… more
- Molina Healthcare (Escondido, CA)
- …live in San Diego County _** **Job Description** **Job Summary** Molina Health Plan Network Provider Relations jobs are responsible for facility provider ... strategic plan and in compliance with all relevant federal, state and local regulations. Provider Relations staff are the primary point of contact between Molina… more
- Molina Healthcare (New York, NY)
- …and must live in New York _** **Job Description** **Job Summary** Molina Health Plan Network Provider Relations jobs are responsible for network ... compliance with all relevant federal, state and local regulations. Provider Relations staff are the primary point...primary point of contact between Molina Healthcare and contracted provider network . In partnership with Director, manages… more
- Molina Healthcare (Chicago, IL)
- …Remote and must live in Illinois _** **Job Description** **Job Summary** Molina Health Plan Network Provider Relations jobs are responsible for network ... * Develops and deploys strategic network planning tools to drive Provider Relations and Contracting Strategy across the enterprise. * Facilitates strategic… more
- Molina Healthcare (Escondido, CA)
- …must live in San Diego County _** **Job Description** **Job Summary** Molina Health Plan Network Provider Relations jobs are responsible for network ... compliance with all relevant federal, state and local regulations. Provider Relations staff are the primary point...primary point of contact between Molina Healthcare and contracted provider network . They are responsible for … more
- Molina Healthcare (New Braunfels, TX)
- …and must live in Bexar County _** **Job Description** **Job Summary** Molina Health Plan Network Provider Relations jobs are responsible for network ... compliance with all relevant federal, state and local regulations. Provider Relations staff are the primary point...primary point of contact between Molina Healthcare and contracted provider network . They are responsible for … more
- Prime Care Coordination (Webster, NY)
- Summary The Provider Relations Representative serves as the primary contact between providers and the organization. The position is responsible for servicing ... and servicing physicians, hospitals and ancillary providers within established guidelines. Provider Relations works closely with all other internal departments… more
- VNS Health (Manhattan, NY)
- …programs, including Medicare and Medicaid , preferred + Prior experience in Provider Relations , preferred + Reliable transportation to work sites, required ... OverviewManages all aspects of provider relations within a specified geographic...Operations departments to administer demographic changes and renewals to provider contracts. + Monitors contract performance of network… more
- Elevance Health (Metairie, LA)
- …for local marketing and community relations , network development, provider partnerships, provider relations , medical management, case management and ... in accordance with applicable regulatory requirements; ensures alignment and support with overall Medicaid Business Unit mission, goals and objectives. + Responsible… more
- VNS Health (Manhattan, NY)
- …Minimum one year of health care experience, required + Prior experience in Provider Relations and contracting, preferred + Knowledge of government programs, ... OverviewPlays a key role in supporting our VNS Health Upstate Network . Assists with building relationships with providers, assisting with operational tasks (such as… more
- Dignity Health (Bakersfield, CA)
- …local human resources that put patient care first. **Responsibilities** As a Provider Relations Representative with the Dignity Health Management Services ... and articulate the processing of eligibility, authorizations and claims adjudication to the provider network + Are capable of continually re-prioritizing to meet… more
- LA Care Health Plan (Los Angeles, CA)
- Provider Network Account Manager II Job Category: Provider Relations Department: Provider Network Management Location: Los Angeles, CA, US, 90017 ... public agency created by the state of California to provide health coverage to low-income Los Angeles County residents....net required to achieve that purpose. Job Summary The Provider Network Account Manager II is responsible… more
- Henry Ford Health System (Troy, MI)
- The Director, Provider Network Management (PNM) with Health Alliance Plan (HAP), will be responsible for provider contracting and management of provider ... strategic relationships and direction of key operations related to network development, physician/hospital contracting, APM contracts, provider services and… more
- Centene Corporation (Trenton, NJ)
- …Bachelor's degree in related field or equivalent experience. 0-2 years of provider relations or contracting experience. Knowledge of health care, managed ... for resolution + Receive and effectively respond to external provider related issues + Provide education on...oversee testing and completion of change requests for the network + Investigate, resolve and communicate provider … more
- Humana (Richmond, VA)
- …Bachelor's Degree with 4+ years of progressive experience in managed care operations, including network management and provider relations **OR** 7+ years of ... to provide the Perfect Experience in all provider interactions with Humana's Virginia Medicaid plan...progressive experience in managed care operations, including network management and provider relations … more