- Elevance Health (Rocky Hill, CT)
- The Cost of Care Mgr leads and manages...acumen. + 2 years experience in broad-based analytical, managed care payor or provider environment as well as ... multiple cost of care initiatives enterprise wide (eg local, within each state,... improvement processes around physician, hospital and ancillary network contract negotiation strategies, utilization management efforts, new products, annual… more
- The Cigna Group (Bloomfield, CT)
- …quality reviews of Practitioner and/or Facility/Ancillary contracts. Conducts comparison of contract data relative to provider data and/or demographic and ... professional advice and creates initial reports/analyses for review. May provide guidance, coaching, and direction to more junior members...and recruit dental providers to become a Cigna network provider + Work to achieve contract discounts… more
- Sedgwick (Hartford, CT)
- …negotiate fee-for-service ancillary contracts for multiple lines of business in managed care markets; to maintain provider participation within the network; and ... Taking care of people is at the heart of...or university preferred. **Experience** Four (4) years of progressive provider network contract negotiation experience or equivalent… more
- CBRE (Hartford, CT)
- …basis and present these reports. Align cost plan with project master schedule; provide cost guidance and direction to achieve cost goals with ... costing of LEED/sustainability initiatives (as appropriate). + Review all invoices against cost plan; provide valuation services and signoff to project team… more
- Humana (Hartford, CT)
- …completes a review that includes a full analysis of the medication care plan, investigation of overall utilization, and identification of unusual usage patterns. ... Intervenes and advises patients and providers to promote cost effective utilization and quality patient outcomes, as needed. Understands department, segment, and… more
- Hartford HealthCare (Wethersfield, CT)
- …of health care finance and/or accounting issues . Knowledge of cost accounting and EPSi highly desired . Strong interpersonal and communication skills essential ... the system. *_Position Summary:_* Reporting directly to the Manager of Payer Contract Analytics, the Sr. Payer Analyst develops a modeling process for negotiated… more
- Sharecare, Inc. (Hartford, CT)
- …-effective manner while ensuring high quality care . The RN coordinates with the Primary Care Provider and all other members of the health care team to ... increasing acuity, and for intervening with the participants and their Primary Care Provider according to the disease management program intervention guidelines.… more
- The Cigna Group (Bloomfield, CT)
- …of our practice is: + Comprehensive Health Risk Assessments (HRA): health plans contract with ENHB care to conduct in-home comprehensive health assessments in ... a division of Cigna, is the premier home-based healthcare provider and medical services company. We are an innovative,...**Duties & Responsibilities:** + Works to achieve quality medical care and outcomes for patients, in a cost… more
- Option Care Health (Hartford, CT)
- …alternative to hospital infusion therapy. With more than 2,900 clinical experts, Option Care Health is able to provide high-quality infusion services for nearly ... resulting in high quality outcomes at a significantly reduced cost . Option Care Health has more than...treatment sites. We are guided by our purpose to provide extraordinary care that changes lives through… more
- Hartford HealthCare (Hartford, CT)
- …the organization is supported through data and evidence-based evaluation of cost containment, utilization, standardization and contract compliance opportunities. ... leaders to develop sound business case by integrating multiple sources of data ( cost & clinical). Serves as a subject matter expert to promote and educate… more
- Elevance Health (Rocky Hill, CT)
- …for autism and depression, and insightful analytics to improve the delivery of care .** **BH Care Manager II** Responsible for authorizing and reviewing ... needs to ensure access to medically necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract .… more
- Elevance Health (Rocky Hill, CT)
- …needs to ensure access to medically necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract . ... + Will serve as a resource to other BH Care Managers. + Assists with more complex cases and...or any combination of education and experience which would provide an equivalent background. + Current active unrestricted license… more
- Elevance Health (Wallingford, CT)
- …needs to ensure access to medically necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract . ... + Will serve as a resource to other BH Care Managers. Assists with more complex cases and may...or any combination of education and experience which would provide an equivalent background. + Current active unrestricted license… more
- The Cigna Group (Bloomfield, CT)
- …as needed. + Strong understanding of Provider Contracting & contract negotiations. In-depth understanding of managed care business processes, data, ... non-technical stakeholders. + Deep familiarity with health insurance data, including contract structure and methodologies, claims, eligibility, provider and… more
- IMSolutions, LLC (Hartford, CT)
- …to work at the agency's office in Washington, DC._** As a **Federal Contract Specialist** , you provide acquisition support services, including contract ... and contract closeouts. + Market research/analysis, selection and administration of contract terms and conditions, cost , and price analysis. + US Citizenship… more
- Prime Therapeutics (Hartford, CT)
- …satisfaction. Develops and tracks the appropriate metrics to monitor the quality and care cost impact of the client's program. Requires communication across all ... empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members. If… more
- CVS Health (Hartford, CT)
- …of Aetna's Dental Products and market position. The Senior Analyst negotiates provider contract language and compensation. This role is responsible to ... and implement cost saving strategies. + Collaborates cross-functionally to resolve provider issues with the utmost urgency. + Recruits providers as needed to… more
- Humana (Hartford, CT)
- …Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims ... cost reduction, by increasing the accuracy of provider contract payments in our payer systems,...peer reviews to ensure compliance with coding guidelines and provide reports as needed + Maintain strict patient and… more
- Baystate Health (Springfield, MA)
- …+ Health New England (https://www.healthnewengland.org/) , a health insurance provider + Home care and hospice services ... is the largest healthcare organization in western Massachusetts. The care we provide plays an essential role...OF WORKING WITH BAYSTATE** + Excellent Compensation + High-quality, low- cost medical, dental and vision insurance + Generous PTO… more
- Sedgwick (Hartford, CT)
- Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our ... To analyze complex or technically difficult surety and surety bond claims; to provide resolution of highly complex nature and/or high exposure surety claims; to… more