- Credence (Wright-Patterson AFB, OH)
- …support our clients' mission-critical needs, powered by technology. We provide cutting-edge solutions, including AI/ML, enterprise modernization, and advanced ... Responsibilities include, but are not limited to the duties listed below Provide subject matter expertise / knowledge of, and technical experience in, acquisition… more
- Elevance Health (Mason, OH)
- ** Provider Contract / Cost of Care Consultant Senior** **Location:** This role requires associates to be in-office 1 day per week, fostering collaboration ... 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
- Elevance Health (Mason, OH)
- ** Provider Contract Cost of Care Analyst Senior** **Location:** This role requires associates to be in-office 1-2 days per week, fostering collaboration ... granted as required by law. 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 (Columbus, OH)
- ** Cost of Care / Provider Contracting Data Analyst** **Location** : This role requires associates to be in-office 1-2 days per week, fostering collaboration ... an accommodation is granted as required by law. The ** Cost of Care / Provider Contracting Data...contract negotiation process. + Can work with multiple provider types, eg physician, ancillary, medical groups, or hospitals.… more
- Elevance Health (Mason, OH)
- …office. **Position Overview:** Provides the highest level of analytical support to the Cost of Care and/or Provider Contracting organizations. Focuses ... develop contracting strategy and supports all aspects of the contract negotiation process. Works with multiple provider ...modifications as applicable + Recommends standardized practices to optimize cost of care + Educates provider… 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
- Centene Corporation (Columbus, OH)
- …account management and accountability for issue resolution. Drive optimal performance in contract incentive performance, quality, and cost utilization. + Serve ... and align to performance-based agreements that incentivize better patient outcomes, cost -efficiency, and quality care . + Performance Management: Uses data… more
- The Cigna Group (Cleveland, OH)
- …analyzes, reviews, and projects financial impact of high spend or increasingly complex provider contracts and alternate contract terms. + Manages key provider ... understanding and experience with larger, more complex integrated delivery systems, managed care , and provider business models. + Team player with proven… more
- Elevance Health (Columbus, OH)
- Provider Success Consultant Sr. (Ohio Market) **Location:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and ... This position will require the candidate to travel to provider locations in Ohio at a minimum of 50%...at a minimum of 50% of the time. **The Care Consultant Sr.** is responsible for fostering long-term partnerships… more
- Molina Healthcare (Cincinnati, OH)
- …supports assigned contracts with VBC providers that result in high quality and cost -effective care . Maintains tracking system and publishes reports according to ... Qualifications** **REQUIRED EDUCATION:** Bachelor's Degree or equivalent work experience in health care field including, but not limited to, provider 's office,… more
- CVS Health (Columbus, OH)
- …ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we reach millions ... all with heart, each and every day. **Position Summary** The Lead Director, Provider Portal Strategy & Operations is responsible for the strategic leadership and… more
- ProMedica Health System (Toledo, OH)
- …any funded research study. + Assists in reviewing budgets for consistency with contract terms and institutional cost principles. + Drafts appropriate amendments ... duties listed below are essential unless noted otherwise* + Evaluates contract terms to ensure compliance with ProMedica policies, applicable governmental… more
- CVS Health (Columbus, OH)
- …ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we reach millions ... and alignment with organizational goals to ensure the delivery of exceptional provider experiences and operational excellence. This role serves as the primary… more
- Molina Healthcare (Cincinnati, OH)
- …standards, practices, policies and contractual commitments. Contributes to overarching strategy to provide quality and cost -effective member care . Essential ... related business documents. Required Qualifications * At least 5 years of health care experience, including experience in clinical operations, and at least 3 or more… more
- Molina Healthcare (Columbus, OH)
- …claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and ... cost containment reports and makes recommendations based on relevant...materials and documentation archives. + Demonstrate Healthcare experience in contract modeling, analyzing relevant Financial and Utilization Metrics of… more
- Molina Healthcare (Dayton, OH)
- …other cost recovery processes + Direct PM experience in Managed Care Operations (claims, system configuration, provider data management preferred) + ... Builds work breakdown structures, monitors task activities, and ensures state contract timelines are met. Monitors the project from inception through delivery.… more
- Molina Healthcare (Dayton, OH)
- …delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost -effective member care . Essential Job Duties * ... Assesses services for members to ensure optimum outcomes, cost -effectiveness and compliance with all state/federal regulations and guidelines. * Analyzes clinical… more
- Molina Healthcare (Akron, OH)
- …underperforming and problematic contracts. Supports multi-dimensional pricing strategies to drive down total cost of care and minimize variation in cost by ... financial impact. * Work independently to support and validate Provider Network contracting and unit cost management...Provides peer review of team members' presentations for total cost of care and profit improvement initiatives… more
- Molina Healthcare (Cleveland, OH)
- …underperforming and problematic contracts. Supports multi-dimensional pricing strategies to drive down total cost of care and minimize variation in cost by ... financial impact. + Work independently to support and validate Provider Network contracting and unit cost management...Provides peer review of team members' presentations for total cost of care and profit improvement initiatives… more
- CVS Health (Columbus, OH)
- …key providers, ensuring timely resolution of escalated issues such as claims, contract interpretation, and provider data accuracy. + Negotiate settlements and ... **Required Qualifications** + 5+ years of behavioral health facility and provider contracting and relationship experience, including contract language, rate… more
