- CVS Health (Springfield, IL)
- …And we do it all with heart, each and every day. **Position Summary** The Medicaid Network Provider Relations Manager oversees our Medicaid ... * Minimum of 2 years' experience with Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and … more
- Molina Healthcare (GA)
- …must live in Georgia _** **JOB DESCRIPTION** **Job Summary** Molina Health Plan Provider Network Management and Operations jobs are responsible for network ... strategic plan and in compliance with all relevant federal, state and local regulations. Provider Network staff are the primary point of contact between Molina… more
- Humana (Detroit, MI)
- …health care or managed care experience working with providers (eg, provider relations , claims education). + Experience with Michigan Medicaid + Knowledge of ... community and help us put health first** The Senior Provider Relations Professional is responsible for fostering... network providers that participate in Michigan's Humana Medicaid Program. Day-to-day work includes conducting provider … more
- Molina Healthcare (GA)
- …Remote and must live in Georgia _** **Job Description** **Job Summary** Molina Health Plan Network Provider Relations jobs are responsible for network ... strategic plan and in compliance with all relevant federal, state and local regulations. Provider Relations staff are the primary point of contact between Molina… more
- Molina Healthcare (Detroit, MI)
- …Remote and must live in Michigan _** **Job Description** **Job Summary** Molina Health Plan Network Provider Relations jobs are responsible for network ... * Develops and deploys strategic network planning tools to drive Provider Relations and Contracting Strategy across the enterprise. * Facilitates strategic… more
- Molina Healthcare (Buffalo, NY)
- …and must live in New York _** **Job Description** **Job Summary** Molina Health Plan Network Provider Relations jobs are responsible for network ... compliance with all relevant federal, state and local regulations. Provider Relations staff are the primary point...primary point of contact between Molina Healthcare and contracted provider network . They are responsible for … more
- Molina Healthcare (Ramapo, NY)
- …Counties for provider visits _** **Job Description** **Job Summary** Molina Health Plan Network Provider Relations jobs are responsible for network ... compliance with all relevant federal, state and local regulations. Provider Relations staff are the primary point...primary point of contact between Molina Healthcare and contracted provider network . They are responsible for … more
- CareFirst (Baltimore, MD)
- … network projects and outreach initiatives that must be special handled by Provider Relations in order to mitigate risk to CareFirst, supplement existing ... programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** Provider Relations and Education **Equal Employment Opportunity**… more
- Elevance Health (Mason, OH)
- …behavioral health, long term services and supports, and psychosocial needs._ ** Network Relations Consultant Senior (Value-Based Program Specialist) - MyCare ... Monday-Friday, 8:00 AM - 5:00 PM Eastern Time The ** Network Relations Consultant Senior** (Value-Based Program Specialist)...as needed. + Researches issues that may impact future provider negotiations or jeopardize network retention. +… more
- CVS Health (Lawton, OK)
- …**Preferred Qualifications** + Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claim Lifecycle, Provider Appeals & Disputes, ... relationships by assisting with or responding to complex issues regarding Medicaid policies and procedures, plan design, contract language, service, claims or… more
- Dignity Health (Bakersfield, CA)
- **Job Summary and Responsibilities** The Provider Relations Representative is responsible for establishing and maintaining positive relationships with various ... administrator operations such as eligibility, prior authorization, claims administration and provider network administration. Familiarity with managed care and… more
- Highmark Health (Pittsburgh, PA)
- …the market. Partner with and provide both strategic and tactical direction to the provider network contracting team to build and enhance the provider ... SUMMARY** This job leads the overall performance of a Medicaid plan, for quality of care and service as...care, service and financial goals. As needed, engage in provider relations escalated service issues to achieve… more
- CVS Health (Pearland, TX)
- …in Network / Provider Engagement + Employee Supervision with 3-5 Years in Medicaid Network / Provider Engagement. + Travel within the state as needed. + ... for maintaining local policies and procedures. + Manages Local Provider Relations staff to ensure Market Leading...+ Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Lifecycle, Provider Appeals… more
- AmeriHealth Caritas (Detroit, MI)
- …claims submission and auto-adjudication processes. ** Provider Recruitment, Retention, & Relations ** + Ensure network adequacy in accordance with state and ... **Role Overview:** The Manager of Provider Network Management oversees the day-to-day...align with company standards and regulatory requirements. + Ensure provider contracts comply with pricing methodologies, Medicaid … more
- Elevance Health (Las Vegas, NV)
- **Be Part of an Extraordinary Team** **Senior Provider Network Manager** **Location:** NV-LAS VEGAS, 9133 W RUSSELL RD **Hybrid** : **This role requires ... Network Manager** is responsible for developing the provider network through contract negotiations, relationship development,...and a minimum of 5 years' experience in contracting, provider relations , provider servicing; experience… more
- Elevance Health (Seattle, WA)
- …promoting a dynamic and adaptable workplace. **Position Overview:** Develops the provider network through contract negotiations (language and rates), ... and a minimum of 3 years' experience in contracting, provider relations , provider servicing; or...or any combination of education and experience, which would provide an equivalent background. **Preferred Qualifications:** + Experience with… more
- Elevance Health (Overland Park, KS)
- …promoting a dynamic and adaptable workplace. **Position Overview:** Develops the provider network through contract negotiations, relationship development, and ... development planning to include gap fill projects and network adequacy reporting + May provide work...in contracting (value based, shared savings and ACO development), provider relations , provider servicing; experience… more
- Dignity Health (Santa Maria, CA)
- **Job Summary and Responsibilities** JOB SUMMARY / PURPOSE The Client Relations Executive (CRE) makes essential contributions to the achievement of the ... revenue targets, patient experience and profitability goals. The Client Relations Executive II (CRE II), additionally, is a mentor...relationships within RSL on each key referral source to provide client information needed to build strong ties and… more
- Aveanna Healthcare (Philadelphia, PA)
- Client Relations Director ApplyRefer a FriendBack Job Details Requisition #: 208177 Location: Philadelphia, PA 19019 Category: Client Services Salary: $65,000.00 - ... $75,000.00 per year Position Details Position Overview The Client Relations Director is responsible for general sales activity, sales communications, and marketing… more
- Humana (Springfield, IL)
- …+ Ensure compliance with all Virginia managed care contractual requirements for provider relations , such as timeframes for claims dispute resolution, ... years of health care or managed care experience working with providers (eg, provider relations , claims education). + Experience working with physical health… more