- Elevance Health (Woodbridge, NJ)
- ** Provider Contract / Cost of Care Consultant** **Location:** This role requires associates to be in-office 1 day per week, fostering collaboration and ... an accommodation is granted as required by law. The ** Provider Contract / Cost of Care...or any combination of education and experience, which would provide an equivalent background. **Preferred Skills, Capabilities and Experiences:**… more
- Molina Healthcare (New York, NY)
- …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
- CVS Health (Trenton, NJ)
- …to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information. + Negotiates settlements as needed. ... contract negotiator: + Negotiates competitive contracts with health care providers using pre-determined internal guidelines and financial standards. + Negotiates… more
- CVS Health (Trenton, NJ)
- …claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information. **Required Qualifications** -Minimum 4+ ... and adequacy targets. * Responsible for identifying and managing cost issues and initiating appropriate cost saving...provider configurations. - In-depth knowledge of the managed care industry, as well as a strong understanding of… more
- Centene Corporation (New York, NY)
- …management and accountability for issue resolution. Drive optimal performance in contract incentive performance, quality, and cost utilization. + Conducts ... to identify and align to performance-based agreements that incentivize better patient outcomes, cost -efficiency, and quality care + Uses data analytics to track… more
- CVS Health (Trenton, NJ)
- …value based providers in one line of business, less complex Value Based Care models, and/or less sophisticated and smaller provider partnerships, practices, or ... arrangements are functioning successfully and working to improve quality of care while reducing costs. **Key Responsibilities:** + Provider Relationship… more
- Humana (Trenton, NJ)
- …of standardized templates, and policies to promote best practices. + Researchs provider contract details + Compares State Medicaid website payment terms ... in CAS + 2+ years' experience reviewing and interpreting provider contract language + 2+ years' ...and microwave connection can be used only if they provide an optimal connection for associates. The use of… more
- Humana (Trenton, NJ)
- …extensive business leadership experience, with several years in a managed care environment leading a network development/ provider relations function, including ... seeking an accomplished healthcare leader for the position of Vice President, National Provider Network Management. At a high level, this highly visible role will be… more
- Northwell Health (New York, NY)
- **Req Number** 159901 WOCN Certification required. Performs an age specific plan of care for a designated group of patients using the nursing process of assessment, ... diagnosis, outcome identification, planning, implementation and evaluation of patient care . Collaborates with physicians and other health team members in… more
- Molina Healthcare (New York, NY)
- …area.) **Job Qualifications** **REQUIRED EDUCATION** : Bachelor's Degree or equivalent provider contract , network development and management, or project ... provider service, or claims experience in a managed care setting. * 3+ years experience in managed healthcare... Provider Services. * 3+ years experience in provider contract negotiations in a managed healthcare… more
- City of New York (New York, NY)
- …through the review and analysis of standard reporting documents, to ensure contract compliance. - Provide technical assistance to the contractor, respond ... select vocational goals and receive support. Other HASA's services include home care and homemaking services, mental health and substance abuse screening and… more
- Qualus (South Plainfield, NJ)
- **Position Overview** **POWER** your future with Qualus as a Senior Cost Analyst in our Program Management organization. A Senior Cost Analyst provides cost ... forecasting and reporting, budget management and control, change management, contract administration, close-out administration, procurement management, earned value management,… more
- City of New York (New York, NY)
- …complex fiscal procedures, and analysis of budget actions such as funding requests - Provide leadership and direction for Annual Provider Meeting and other ... Division/Program Summary Description: The Bureau of Alcohol and Drug Use Prevention, Care , and Treatment (BADUPCT) works to close gaps and reduce overall morbidity… more
- Centene Corporation (Trenton, NJ)
- …mental and behavioral health needs members to provide high quality, cost -effective healthcare outcomes including personalized care plans and education for ... between the member and/or family/caregivers, community resources, and the care provider team to ensure identified services...care and quality delivery for members in a cost -effective manner + Performs other duties as assigned. +… more
- Centene Corporation (New York, NY)
- …mental and behavioral health needs members to provide high quality, cost -effective healthcare outcomes including personalized care plans and education for ... between the member and/or family/caregivers, community resources, and the care provider team to ensure identified services...care and quality delivery for members in a cost -effective manner + Performs other duties as assigned. +… more
- Molina Healthcare (New York, NY)
- …Manages a team of employees who develop, negotiate, contract and enhance provider networks that are high quality, cost efficient and improve the lives ... * Leads and manages a high performing team who develop, negotiate, contract and enhance collaborative provider relationships, ensuring overall network… more
- Callen-Lorde Community Health Center (New York, NY)
- SUPERVISOR, CARE COORDINATION Job Details Job Location Callen-Lorde Community Health Center - Manhattan - New York, NY Position Type Full Time Salary Range $67000.00 ... Stonewall, we have been transforming lives in LGBTQ+ communities through excellent comprehensive care , provided free of judgment and regardless of ability to pay. In… more
- Humana (Trenton, NJ)
- … efficiency, and population health outcomes through strategic provider partnerships, data-informed decision-making, and cross-functional collaboration. The RVP ... and maintain trusted relationships with CMOs and senior executive/clinical leaders at provider and care delivery partner organizations. First and foremost, this… more
- Prime Therapeutics (Trenton, NJ)
- …value to the customer, derived from identifying, demonstrating and selling valued pharmaceutical care and cost solutions that meet the desired outcomes of the ... fashion. + Demonstrates the value of pharmacy solutions (unit cost , utilization management & patient care enhancement)....achievements. We value new ideas and work collaboratively to provide the highest quality of care and… more
- Dr. Reddy's Laboratories (Princeton, NJ)
- …GPOs, Integrated Delivery Networks (IDN), institutional/community clinic practices and other provider networks. The person will direct the pricing and reimbursement ... GPO account teams, Field Sales, External customers, Legal and contract teams. The role will report to the Head...Buy & Bill Biologics space. Strong expertise in managed care landscape across medical and pharmacy benefit, commercial and… more