- MultiPlan (Atlanta, GA)
- Provider Contract Specialist - Medicare Advantage and Managed Care (Network Development Specialist) Remote At MultiPlan, we pride ourselves on being a dynamic ... and client expectations through comprehensive, aggressive execution of region specific contracting goals derived from national and regional objectives related… more
- Fidelity TalentSource LLC (Westlake, TX)
- …and contracting process, and developing our carrier relationships. Fidelity Medicare Services provides customers with tools and advice to help them select ... as we look to help millions of Americans make Medicare decisions. You will support our team as we...Company Overview Fidelity TalentSource is the in-house temporary staffing provider for Fidelity Investments, one of the largest and… more
- The Cigna Group (Springfield, IL)
- …an integral member of the Network Development and Solutions Team and reports to the Medicare Provider Contracting Regional Vice President. This role is ... The ** Regional Medicare ** ** Provider Contracting Senior..._###@cigna.com_ _for an update on your application or to provide your resume as you will not receive a… more
- The Cigna Group (Scottsdale, AZ)
- …as construct a united negotiation strategy with our Medical Commercial and Medicare contracting and Network Strategy Leadership. + Design innovative contract ... Provider Relationship and Service Management experience. + Technical/Functional expertise: provider contracting , provider relations and negotiation. +… more
- Humana (Albany, NY)
- …development + Leadership of approximately 250 associates focused in the areas of Provider Contracting , Provider Engagement and Quality, Risk Adjustment, ... Reporting to the East Division Senior Vice President, the Regional Market President manages the development, operations, and business...Master's or JD degree + Record of success leading provider contracting and provider engagement… more
- Merck (North Wales, PA)
- …+ LTC + National and regional health plans and PBMs (Commercial, Managed Medicaid, Medicare Part D) The US Market Access Contracting Team acts as a unique ... **Job Description** The Director, US Market Access Contracting sits within the National Contract Operations and...personnel for complex, integrated customers, including HP/PBM or Hospital/GPO Provider accounts who have a large national impact in… more
- Humana (Baton Rouge, LA)
- …relationships related to profitability. *Assist with network development and provider contracting with various providers and ancillary providers. ... of how organization capabilities interrelate across segments and/or enterprise-wide. The Regional VP, Health Services will provide medical leadership and… more
- Henry Ford Health System (Troy, MI)
- … Network Management (PNM) with Health Alliance Plan (HAP), will be responsible for provider contracting and management of provider relations for assigned ... (7) years' experience in the health care field with three (3) years provider contracting experience with hospitals, health systems and professionals. Experience… more
- Highmark Health (Harrisburg, PA)
- …:** **JOB SUMMARY** This job is the primary liaison between strategically aligned provider groups in the Highmark Network. The incumbent will be responsible for ... cultivating relationships with these large, complex provider groups and entities, including ancillary provider networks, independent physician organizations and… more
- The Cigna Group (Bloomfield, CT)
- …Development and Competitive Insights Team within Network Operations and Provider Contracting and reports to the Regional Network Access Lead. This role ... and Medicare Advantage products. Works closely with Contracting , Network Solutions, Network Operations, Provider Services,...+ Provide analytic and reporting support for regional provider network access build initiative projects.… more
- CVS Health (Sacramento, CA)
- …management, medical policy development, pharmacy management, quality improvement, population health, provider network development, provider contracting and ... Medicare ) and cost, delivering strategic network goals. Ensure all contracting efforts with hospital/ provider systems deliver appropriate outcomes **… more
- Scripps Health (San Diego, CA)
- …operational leadership in the development and execution of all types of payer contracting programs and provider partnership strategies for all lines of business ... to exercise independent judgment in the day-to-day management of the organization's contracting and managed care activities. * You will proactively support the… more
- MetroLink (Los Angeles, CA)
- …a subject matter expert on Metrolink's business development programs and provide consultation and analyses/recommendations on related issues. + Initiate and manage ... the development and on-going monitoring of Metrolink's Mentor/Protege Program. + Provide oversight and monitoring of contractors/consultants assigned to provide … more
- MetroLink (Los Angeles, CA)
- …supervise full-time or part-time staff and may be called on to provide mentorship to lower classifications. ESSENTIAL DUTIES AND RESPONSIBILITIES The duties listed ... drafting Board reports; and presenting to the Board of Directors. + Provide answers to contractors' questions regarding the bid process and other compliance… more
- MetroLink (Los Angeles, CA)
- …Act covered work. Knowledge, Skills, and Abilities Knowledge of: + Public contracting principles. + California and Federal laws applicable to procurement for public ... noises (85+ decibels, such as heavy trucks, construction, etc.) Southern California Regional Rail Authority is an Equal Opportunity Employer. In compliance with the… more
- Wellpath (Nashville, TN)
- …or complex national providers. + Experience with provider contracts, contracting options, contract terms, reimbursement structure ( Medicare /Medicaid) as well ... have the distinct honor and responsibility to show up with non-judgmental compassion to provide hope and healing to those who need it most. For those whose calling… more
- Molina Healthcare (Starkville, MS)
- …management policies and procedures to improve quality outcomes and decrease costs. * Provide regional medical necessity reviews and cross coverage * Standardizes ... Medicare . **Preferred Experience** * Peer Review, medical policy/procedure development, provider contracting experience. * Experience with NCQA, HEDIS,… more
- CVS Health (New Albany, OH)
- …achievement of quality performance and leadership of Aetna's quality government programs ( Medicare , Medicaid, IFP, Duals). This leader will focus on HEDIS Hybrid, ... STARS, Performance Improvement Plans, provider & member enablement, regulatory and accreditation compliance. This...our goals. This includes, but not limited to, network, contracting , member service, and business leaders across the enterprise… more
- Dartmouth Health (Lebanon, NH)
- …Program. The role will also administer oversight to comply with Medicare Advantage directed First-Tier Downstream Related Entity (FDR) compliance program. ... compliance with value-based payment programs objectives by reviewing individual provider , clinic, and participant reports to identify potential issues and… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …financial leadership and analysis to the Population Health (PH) corporate and regional operating entities. The role translates actuarial and management guidance into ... The role requires prior experience working in health insurance, value-based care contracting , accountable care, or other risk-based health care delivery due to the… more
