- Molina Healthcare (Dayton, OH)
- …payment integrity and other cost recovery processes + Direct PM experience in Managed Care Operations (claims, system configuration, provider data management ... + 3-5 years in Managed Care with emphasis on Managed Care Operations **Preferred License, Certification, Association** + PMP, CAPM, PMI-ACP, PMI-PBA… more
- Molina Healthcare (Cleveland, OH)
- …Qualifications** + At least 6 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent ... + Provides status and updates to health plan/product team partners, senior management and stakeholders. + Communicates requirement interpretations and changes to… more
- Molina Healthcare (Akron, OH)
- …+ 3 - 5 years customer service, provider service, or claims experience in a managed care setting. + 3-5 years' experience in managed healthcare ... DESCRIPTION** **Job Summary** Molina Health Plan Provider Network Management and Operations jobs are responsible for network development, network adequacy and… more
- Humana (Columbus, OH)
- …the IHWA Follow-up Senior Program Delivery Professional, will support IHWA Care Management Referrals as back-up for daily operations responsible for ensuring ... and help us put health first** The IHWA Follow-up Senior Program Delivery Professional provides daily operational support to...or IHWA experience + Knowledge and experience in health care environment/ managed care **Additional Information**… more
- Humana (Columbus, OH)
- …us put health first** This role supports Medicaid state reporting initiatives for its managed care operations across multiple states. This role ensures ... reporting logic + Exposure to CMS reporting standards + Experience with Medicaid managed care organizations + Prior experience supporting Medicaid contracts +… more
- Molina Healthcare (Cincinnati, OH)
- …+ Proven experience handling provider disputes, appeals, and overpayment recoveries in a managed care or payer environment. + In-depth knowledge of medical and ... **JOB DESCRIPTION** **Job Summary** Provides senior level support for accurate and timely intake...4 years of experience in previous roles in a managed care organization, health insurance or directly… more
- Humana (Columbus, OH)
- …+ Bachelor's Degree. + Three (3) or more years of experience in managed care operations , provider reimbursement and analytics and/or value-based ... reporting, and scorecard/reconciliation reporting. + Understanding of Medicaid and/or Medicaid managed care . + Ability to understand and analyze financial,… more
- Banner Health (OH)
- …Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you'll find many options ... of diagnoses and operations , or an Associate's degree in a health care field. Requires Certified Coding Specialist (CCS) or Certified Outpatient Coder (COC) or… more
- Humana (Columbus, OH)
- …in claims analysis, payment integrity, or healthcare data analytics, preferably within a managed care or payer environment. + Advanced proficiency in data mining ... caring community and help us put health first** The Senior Payment Integrity Professional uses technology and data mining,...payment integrity. + Familiarity with audit processes and recovery operations in a payer environment. + Experience in a… more
- Datavant (Columbus, OH)
- …sciences companies, government agencies, and those who deliver and pay for care . By joining Datavant today, you're stepping onto a high-performing, values-driven ... realize our bold vision for healthcare. **Job Summary** The Senior Manager, Facilities at Datavant will lead all aspects...Facilities at Datavant will lead all aspects of facilities operations across our locations around the world, ensuring safe,… more
- Merck (Columbus, OH)
- …of their current practice structure, business model, and key influencers ( Managed Care Organization/payers, employers, state policy), and their patients' ... Improvement, Health Outcomes, Hospital Sales, Interpersonal Relationships, Lead Generation, Managed Care , Market Analysis, Pharmaceutical Sales Training, Sales… more
- CVS Health (Columbus, OH)
- …proven experience leading clinical or medical management projects in a healthcare or managed care environment. + Strong analytical skills with proficiency in ... ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we reach millions… more
- Molina Healthcare (Columbus, OH)
- …or equivalent combination of education and experience **Required Experience** + 3-5 years managed care experience, including 2+ years in Provider Claims and/or ... level (or higher) **Preferred Education** Bachelor's Degree **Preferred Experience** + 5+ years managed care experience + QNXT; SQL experience + Crystal Reports… more
- CVS Health (New Albany, OH)
- …**Required Qualifications** + Associate degree or equivalent combination of education and health care operations experience. + 4+ years of experience in provider ... management, or healthcare analytics. + Strong understanding of healthcare delivery systems, managed care , and provider contracting, and surveys. + Proficiency in… more
- Highmark Health (Columbus, OH)
- …auditing, investigations, regulatory accreditation, process improvement, project management and/or managed care operations **Knowledge, Skills and ... and policies and regulatory bodies; performing and providing oversight of the care management delegation functions of multiple vendors through review of annual… more
- Cardinal Health (Columbus, OH)
- …+ Oversee the ongoing training needs of the customer, the ISF, and the Managed Care Support Team including conducting regular webinar trainings. + Analyze ... + Communicate updates within region to key internal stakeholders within sales, operations , and marketing. **_Qualifications_** + 2-4 years of experience preferred +… more
- Centene Corporation (Columbus, OH)
- …**Education/Experience:** Current state RN license preferred. Previous experience in a managed care organization strongly preferred. 3+ years of leadership ... The Vice President of Population Health & Health Outcomes is a senior leadership role responsible for developing and executing strategies that drive measurable… more
- Prime Therapeutics (Columbus, OH)
- …performance indicator (KPI) metrics; track and report on performance; provide reporting to senior management on operations and the state of corporate enterprise ... purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven...**Job Posting Title** IT Manager - Cybersecurity Engineering & Operations - Remote **Job Description** The IT Security Manager… more
- CenterWell (Columbus, OH)
- …+ Previous Commercial, Medicare and/or Medicaid experience + Previous clinical experience in managed care **Additional Information** + This is a remote position ... and help us put health first** The Staff Specialty Operations Pharmacist applies clinical and operational knowledge to ensure...at the center. As the nation's largest provider of senior -focused primary care , one of the largest… more
- Cardinal Health (Columbus, OH)
- …strategic C-suite and senior executive leadership partnerships with payers and managed care organizations + Comprehensive understanding of the evolving ... covering both strategic hunting and complex account management with payers and managed care organizations. By combining rigorous performance management with… more