- Humana (Little Rock, AR)
- …Pricer Business and System Support team responsible for administering complex Medicaid provider reimbursement methodologies. The associate will support existing ... be primarily responsible for implementation, maintenance and support of Medicaid provider reimbursement for hospitals and facilities....closely with IT, the pricing software vendor, CIS BSS, Medicaid operations , claims operations , and… more
- Humana (Columbus, OH)
- …premiums. Deliver project-based and ad-hoc reporting for Medicaid markets; provide insights into membership analysis, provider performance, RFPs, and market ... the Finance team and partners directly with Market CFOs, clinical teams, and provider engagement teams, focusing on Medicaid claims and premium analytics across… more
- Commonwealth Care Alliance (Boston, MA)
- …of health (SDOH) measures. The Program Manager will work collaboratively with our provider network and Quality teams to identify quality metrics that align ... performance improvement. Analyze CAHPS results to identify trends and collaborate with Provider Network , Clinical and Quality teams to address performance gaps.… more
- AmeriHealth Caritas (Newtown Square, PA)
- …Discover more about us at www.amerihealthcaritas.com. Role Overview: ; The Corporate Provider Network Management Account Executive is vital in building strong, ... preferred. 2 to 3 years of previous experience in Medicaid or Medicare Provider Contracting preferred. 5...5 to 7 years of progressive business experience in provider network management. In-depth knowledge of … more
- Commonwealth Care Alliance (Boston, MA)
- …problem-solving. Represent CCA's behavioral health priorities, programs, and initiatives to the provider network . Promote provider understanding of CCA's ... Health, Health Home, Network , and Clinical teams to ensure a seamless provider experience and consistent delivery of quality care. The BH Provider Engagement… more
- Molina Healthcare (Grand Rapids, MI)
- … services, operations , and/or contract negotiations in a Medicare and Medicaid managed healthcare setting, ideally with different provider types (eg, ... Remote and must live in Michigan Job Description Job Summary Molina Health Plan Network Provider Relations jobs are responsible for network development, … more
- Molina Healthcare (Cleveland, OH)
- JOB DESCRIPTION Job Summary Molina Health Plan Provider Network Management and Operations jobs are responsible for network development, network ... Services staff are the primary point of contact between Molina Healthcare and contracted provider network . They are responsible for the provider training, … more
- Molina Healthcare (Warren, MI)
- JOB DESCRIPTION Job Summary Molina Health Plan Provider Network Management and Operations jobs are responsible for network development, network ... Services staff are the primary point of contact between Molina Healthcare and contracted provider network . They are responsible for the provider training, … more
- Cardinal Health (Salem, OR)
- What Network and Payor Relations contributes to Cardinal Health Marketing is responsible for assessing customer needs, market conditions and competition to inform ... through developing, commercializing and monitoring the appropriate products and services. Network and Payor Relations is responsible for the development and… more
- Commonwealth Care Alliance (Boston, MA)
- …Desired Knowledge, Skills, Abilities & Language (nice to have): Familiarity with provider network management systems and healthcare data standards. Project ... have direct reports. Essential Duties & Responsibilities: Support LTSS network program operations o Developing agendas, taking,...the development of reports to share with CBOs to provide information about their operations and performance… more
- Humana (Oklahoma City, OK)
- …is seeking a Senior Fraud & Waste Investigator to join the Oklahoma Medicaid Team. This team of Investigators conducts investigations into allegations of fraud, ... abuse involving providers who submit claims to Humana's Oklahoma Medicaid line of business. As the Senior Fraud and...plans Assess records and independently refer suspected member fraud, provider fraud, and member abuse cases to the Oklahoma… more
- CVS Health (Boston, MA)
- …on behalf of Elevance Health/CarelonRx across all lines of business (Commercial, Medicaid , Medicare Part D, etc.). In addition, the manager works cross-functionally ... and/or other Plan Sponsors. Support the development and maintenance of the Provider Manual and Provider Manual amendments, New Implementation Notices, Formulary… more
- CVS Health (Columbus, OH)
- …will support network across all lines of business. Understanding business operations to identify gaps and areas where new controls are required The facilitation ... Advance working knowledge of business systems, applications, and tools supporting network management, contracting, and provider data systems Experience in… more
- AmeriHealth Caritas (Philadelphia, PA)
- …strategies for positive media coverage. Works closely with the member engagement and provider network management teams to identify and develop member, ... more about us at www.amerihealthcaritas.com . Job Summary Reporting to the Medicaid health plan Market President with accountability to Corporate Communications and… more
- Molina Healthcare (Grand Rapids, MI)
- …from functional areas such as finance, health care services and provider contracting to translate analytic observations into meaningful clinical/operational actions ... into actions/interventions to improve financial performance. Advanced understanding of Medicaid and Medicare programs or other health care plans. Advanced… more
- Prime Therapeutics (Lansing, MI)
- …and provide strategic consultation Proactively build and maintain a network of key relationships to continuously understand business dynamics and appropriately ... lookout for a Principal Solution Strategist to help lead the Medicare and Medicaid migrations for the JUDI program. Job Description The Principal Solution Strategist… more
- Humana (Phoenix, AZ)
- …not limited to - actuarial, product strategy, product strategy advancement, and network , about the evolving footprint in accordance with Humana Dental's overall ... to participate as a QDP with respect to Exchange operations and integration for Federal and State Based health...a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office associates with telephone equipment… more
- Cardinal Health (Phoenix, AZ)
- …in Payors, PBMs, Specialty Hubs, Patient Services, Patient Assistance Programs, Medicaid , and Pharmacy Operations . Exceptional communication, executive presence, ... Sonexus Access and Patient Support combines best-in-class program and pharmacy operations with smart digital tools to streamline patient onboarding and increase… more
- AmeriHealth Caritas (Charleston, SC)
- …reimbursement set up. + Ensure that provider payment issues submitted by Provider Network Management or any other source are validated, researched and ... job is to be responsible for the maintaining current provider data and provider reimbursement set up,...healthcare claims payment configuration process/systems and its relevance/impact on network operations . + 1 to 2 years… more
- Humana (Annapolis, MD)
- …Pricer Business and System Support team responsible for administering complex Medicaid provider reimbursement methodologies. The associate will support existing ... be primarily responsible for implementation, maintenance and support of Medicaid provider reimbursement for hospitals and facilities....closely with IT, the pricing software vendor, CIS BSS, Medicaid operations , claims operations , and… more
