- Elevance Health (Atlanta, GA)
- ** Provider Contract Cost of Care Consult Senior** **Location:** This position will work a hybrid model (remote and office). The Ideal candidate will live ... our Elevance Health PulsePoint locations. The ** Provider Contract Cost of Care Consult...or any combination of education and experience which would provide an equivalent background. **Preferred Skills, Capabilities, and Experiences:**… more
- Elevance Health (Indianapolis, IN)
- ** Provider Contract Cost of Care Analyst Senior** **Location:** This role requires associates to be in-office **1 - 2** days per week, fostering ... Alternate locations may be considered. The ** Provider Contract Cost of Care Analyst...or any combination of education and experience which would provide an equivalent background. **Preferred Skills, Capabilities, and Experiences:**… more
- Elevance Health (Norfolk, VA)
- …** Cost of Care Analyst Senior** provides analytical support to the Cost of Care and/or Provider Contracting organizations. Focuses efforts on ... Medical Directors, contract negotiators and management on cost of care issues to help reduce...modifications as applicable. + Recommends standardized practices to optimize cost of care . + Educates provider… more
- Corewell Health (Grand Rapids, MI)
- …of contracts and passion for problem solving? Corewell Health is seeking a Senior Provider Contract Specialist to take ownership of provider contracts at ... through execution, compliance and renewal. Provides support for management of medical cost of care and efficiency initiatives. Additionally, this position… more
- Avera (Des Moines, IA)
- …Forward for you and our patients. Work where you matter.** **A Brief Overview** The Provider Contract Manager is a critical member of Avera Health Plans (AHP) ... implementation of broad based, tiered, and narrow network products and value-based contract arrangements. Also lead medical cost reduction programs to identify… more
- Corewell Health (Grand Rapids, MI)
- …understanding of contracts and passion for problem solving? Priority Health is seeking a Provider Contract Specialist to take ownership of provider contracts ... guidance in others. Essential Functions + Contributes to the contract development and negotiation process for provider ...contracts and contract information in the system contract database. + Provide effective oversight of… more
- The Cigna Group (Cleveland, OH)
- …total medical cost and quality. + Drives change with external provider partners by assessing clinical informatics and offering consultative expertise to assist ... reviews, and projects financial impact of larger or complex provider contracts and alternate contract terms. +...partners. + Intimate understanding and experience with hospital, managed care , and provider business models. + Team… more
- CVS Health (Hartford, CT)
- …it all with heart, every single day. We are seeking a **Senior Manager of Provider Contract & Pricing Testing** to join our expanding Testing Center of ... experience managing quality assurance projects. + 5+ years of experience in provider contract testing, claims adjudication systems, quality assurance, or related… more
- Centene Corporation (Providence, RI)
- …risk, shared savings, and global capitation. + Analyze provider performance against contract benchmarks (eg, total cost of care , Stars measures) and ... Dual Eligible Special Needs Plans (D-SNPs). This role is critical in analyzing provider performance, modeling contract terms, and generating insights to guide… more
- UNC Health Care (Raleigh, NC)
- …healthcare team in accordance with privileges approved by the credentialing committee to provide high-quality, cost -effective care to patients within the ... guidelines and other regulatory and accreditation standards. **Join our growing UNC Urgent Care provider team! This is an employed position with UNC Rex… more
- AmeriHealth Caritas (Raleigh, NC)
- …pricing, payment methodologies, and state/federal requirements. + Cultivate high-performing, cost -effective provider networks that support access, quality, and ... preferred. + A minimum of 10 years of progressive experience in managed care with direct accountability for provider contracting, reimbursement strategy, and… more
- Brighton Health Plan Solutions, LLC (Westbury, NY)
- …understanding of contract language * Strong understanding of professional provider cost structures and reimbursement methodologies * Sound knowledge of ... new relationships and contracts as needed with providers and re- contract with existing providers to ensure cost ...as appropriate to incorporate a sound strategic approach to provider network development. The Contract Manager is… more
- CVS Health (Denver, CO)
- …to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information. + Negotiates settlements as needed. ... build collaborative relationships with providers and work cross-functionally to resolve complex provider contract issues. + Highly organized and able to… more
- HCA Healthcare (Campbell, CA)
- …for drafting, reviewing and getting approval from the President of SCCIPA, any Network Provider or ancillary provider contract and its terms. Any deviation ... each individual is recognized. Submit your application for our Contract Specialist opening with HCA Healthcare today and find...years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care ,… more
- Molina Healthcare (Columbus, OH)
- …or other health care environment. * 3+ years experience in provider contract negotiations in a managed healthcare setting ideally in negotiating ... Provider Community that result in high quality, cost effective and marketable providers. Contract /Re-contracting with...5-7 years contract -related experience in the health care field including, but not limited to, provider… more
- UNC Health Care (Butner, NC)
- …healthcare team in accordance with privileges approved by the credentialing committee to provide high-quality, cost -effective care to patients within the ... during psychiatric hospitalization, including transfer to a higher level of medical care when needed.** **Summary:** An Advanced Practice Provider (APP)… more
- Molina Healthcare (Houston, TX)
- …in the negotiation of medical group/IPA and hospital contracting. * Advises Network Provider Contract Specialists on negotiation of individual provider and ... negotiates assigned contracts and letters of agreements with non-complex provider community that result in high quality, cost... provider groups. * 3+ years experience in provider contract negotiations in a managed healthcare… more
- UPMC (Pittsburgh, PA)
- … proposed terms as compared to current contractual terms and other comparable payor contract terms. + Data mine provider and payor financial and operational data ... UPMC Corporate is hiring a Payor Contract Analyst, Senior to join our team! This...is responsible for evaluating and negotiating complex health insurance provider contracts and relationships. As well as assisting and… more
- Sharp HealthCare (San Diego, CA)
- … provider orientation/training and other resources to educate providers and key provider staff on Plan products, processes, and contract terms, both orally ... and provider communications to ensure compliance with regulations and contract requirements.Coordinates plan medical group and provider transitions and… more
- HCA Healthcare (Nashville, TN)
- …including product features, comparisons, operational impact, future pipelines, FDA filings, cost drivers, and market dynamics. Contract Terms and Conditions: ... is incentive eligible. **Introduction** Do you have the career opportunities as a Contract Director you want with your current employer? We have an exciting… more