- 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
- Commonwealth Care Alliance (Boston, MA)
- …improving UM program design, policies, procedures, workflows, and correspondence. - Supports provider relations and provider contracting leaders in the design ... with providers. Ensures integration of utilization management functions with network strategy, vendor relationship management and claims processing. Works closely… 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 (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
- CVS Health (Chicago, IL)
- …benefits and/or contract interpretation * Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes ... Drives the implementation of internal and external solutions to achieve provider satisfaction, cost targets, utilization/performance, network growth, 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 (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
- Highmark Health (Pittsburgh, PA)
- …the market. Partner with and provide both strategic and tactical direction to the provider network contracting team to build and enhance the provider ... SUMMARY** This job leads the overall performance of a Medicaid plan, for quality of care and service as...maintaining strategic relationships within the assigned state, the care provider partners, key vendors, and the community at-large. The… more
- Humana (Baton Rouge, LA)
- …to produce requested or required data elements. This role will support our Medicaid Clinical operations in multiple markets. This role manages recurring ... **Become a part of our caring community and help us put health first** The Medicaid Data and Reporting Analyst integrates data from multiple sources… more
- Elevance Health (Indianapolis, IN)
- …Serves as a clinical pharmacy resource to pharmacy benefit management and pharmacy operations teams. + Ensures compliance of the Medicaid formularies with ... ** Medicaid Formulary Pharmacist Clinical - CarelonRx** **Location:** This...management processes. + Responsible for all member, stakeholder, and provider communications regarding formulary changes. + Ensures appropriate formulary… 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 (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
