- Sumitomo Pharma (Providence, RI)
- **Title: Sr. Manager , Medicaid Contract Administration** **Location: Remote/occasional onsite (if local to MA). Flexible work/life balance.** Sumitomo Pharma ... motivated, and experienced individual for the position of **Sr. Manager , Medicaid Contract Administration.** The Sr. ...of the life science industry specific to the Medicaid payer landscape. The decisions made in this position affect… more
- HealthEdge Software Inc (Providence, RI)
- …door to new value-based reimbursement models, benefits plans and provider contracts . The complete suite of solutions fromHealthEdgedelivers a digital foundation for ... payers specifically designed to fuel a digital transformation, reduce costs, and improve both clinical outcomes and the member experience. **Your impact** **:** + Manage and standardize programs to meet the client's release/deployment and quality criteria. +… more
- HealthEdge Software Inc (Providence, RI)
- …to grow with their organization over time-bringing disparate parts of a payer 's organization together for improved accuracy and insights. The Source platform offers ... Transformation features Medicare and Medicaid content coupled with flexible contract configuration capabilities for Commercial lines of business. Payment Integrity… more
- Prime Therapeutics (Providence, RI)
- …Serves as facilitator and mentor to the clinical liaisons for assigned contract (s). Assists Account Managers with managing overall client relationship and driving ... program. Provides guidance, assistance and mentoring to assist the Account Manager staff in attaining goals. Requires communication across all departments and… more
- CenterWell (Providence, RI)
- …support accreditation requirements + Oversight of home infusion reporting for third party payer contracts + Monitor the following key functions: + Program ... vendors and as necessary + Reviews and updates vendor contracts with procurement as necessary + Ensure that the...of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused on whole-person health by addressing… more
- BrightSpring Health Services (Riverside, RI)
- …timely clearance of new referrals. The Intake Coordinator will report to the General Manager and work in one of two locations: Chicago branch located in Woodridge, ... the referral to a pharmacist. + Understands which insurance companies have contracts with Amerita + Communicates with other departments including Sales and pharmacy… more
- Universal Health Services (Fall River, MA)
- …that all clinical services are in full compliance with applicable regulations and payer contract specifications. This Director will promote the development of ... or LMHC required + Minimum of two years as a clinical supervisor or program manager preferred + Minimum of five years of psych experience preferably in a community… more
- Evolent Health (Providence, RI)
- …to assigned health plan. + Acts as Subject Matter Expert on the contract for their assigned health plan, particularly billing requirements and reviews pricing to ... sure that the claim is billed to the proper payer source, in the proper billing format, with the...contacts with outside individuals on billing issues. + Informs Manager of problem accounts promptly. + Performs schedules hours,… more