- 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 ... improvement. + Analyze CAHPS results to identify trends and collaborate with Provider Network , Clinical and Quality teams to address performance gaps.… more
- Commonwealth Care Alliance (Boston, MA)
- …contracting, quality, compliance, medical management, and analytics teams to advance provider network operations , education, and performance improvement. ... internal and regulatory benchmarks. - Ensure provider network compliance with CMS, state Medicaid agency,...(DSNP) populations preferred. - 10+ years of experience in provider relations, contracting, or network operations… more
- Commonwealth Care Alliance (Boston, MA)
- …+ Facilitate Communications Team in content creation as the subject matter expert for provider network + Maintain inventory of all provider communications ... newsletters are compliant, uniform to CCA brand standards, and provider -friendly + Work with provider network...projects and meeting deadlines. + Strong understanding of Medicare, Medicaid , duals program, and health plan operations ,… 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
- Commonwealth Care Alliance (Boston, MA)
- …+ Prioritize and organize own work to meet deadlines. + Work collaboratively with Provider Network Management staff to ensure an adequate and appropriate ... answered. + Establish regular contact with and visits to provider sites. Visits may include regular operations ...provider network . Participate in contracting strategy discussions… more
- Commonwealth Care Alliance (Boston, MA)
- …+ Prioritize and organize own work to meet deadlines + Work collaboratively with Provider Network Management staff to ensure an adequate and appropriate ... provider network When necessary, participate in contracting...expert of the team + Managed Care experience (preferably Medicare/ Medicaid ) + Experience in health plan provider … more
- Commonwealth Care Alliance (Boston, MA)
- …multiple organizational areas and requires close collaboration with internal leadership, operations teams, and external provider partners. The ideal candidate ... Engagement team is responsible for building and maintaining relationships with key provider partners to advance CCA's network partnership, quality, and… more
- Commonwealth Care Alliance (Boston, MA)
- …multiple organizational areas and involves close collaboration with program leadership, operations teams, and external provider partners. The ideal candidate ... facilitate regular meetings, virtual or in person, with CBOs focused on provider education, program operations , regulatory requirements, performance and care… 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 ... 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
- Abt Global Inc. (Rockville, MD)
- …Information Technology Lead, you will support a large-scale Center for Medicare & Medicaid Services (CMS) project. This role will be contracted through TSPi, a ... for trend analysis and policy impact forecasting. **Policy & Operations Support** + Translate CMS research and policy needs...stakeholders to align IT systems with program goals. + Provide technical leadership to ensure IT solutions meet both… 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
- CVS Health (Trenton, NJ)
- …others at all levels + Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and ... State requirements. + Evaluates, helps formulate, and implements the provider network strategic plans to achieve value-based...Network Value Based Contacting experience with 2-3 years Medicaid Network experience + Must have Microsoft… more
- Humana (Madison, WI)
- …+ 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
- Humana (Baton Rouge, LA)
- …of how organization capabilities interrelate across segments and/or enterprise-wide. The Medicaid Regional VP, Health Services will provide medical leadership ... cases (acute care hospital, LTAC, Acute rehab, SNF) according to the Humana Medicaid Model of Care. *Participate in Quality Operations including chair Quality… more
- Molina Healthcare (ID)
- …trends or other issues related to medical care costs. + Work with clinical, provider network and other personnel to bring supplemental context/insight to data ... on developing financial models to evaluate the impact of provider reimbursement changes + Provide data driven... data driven analytics to Finance, Claims, Medical Management, Network , and other departments to enable critical decision making… more
- AmeriHealth Caritas (Charleston, SC)
- …related to healthcare claims payment configuration process/systems and its relevance/impact on network operations + Knowledge of the delivery of healthcare ... Provider billing requirements and as liaison to the Enterprise Operations Configuration Department + Participate in Provider Reimbursement medical policy… more
- AmeriHealth Caritas (Detroit, MI)
- **Role Overview:** ;The Provider Network Operations Data Analyst plays a key role in maintaining accurate provider data and fostering strong ... across Medicaid , Medicare, and Exchange products. This role ensures provider information is correctly represented in all operating systems and serves as… more
- AmeriHealth Caritas (Washington, DC)
- …satisfaction, education, and communication. This position is also responsible for all provider network recruiting and contracting management activities as it ... provider contracts. + Responsible for implementation of electronic strategies for provider network to include increasing electronic claims submission and… more
- Humana (Oklahoma City, OK)
- …management for network providers in Humana's Healthy Horizons in Oklahoma's Medicaid Plan, including provider onboarding, training, education, responding to ... provider experience with Humana Healthy Horizons and promote network retention + Meet regularly, both in person and...to provide the Perfect Experience in all provider interactions with Humana's Oklahoma Medicaid plan… more
