- Health Care Service Corporation (Richardson, TX)
- …purpose-driven company that will invest in your professional development. The Provider Contracting & Network Adequacy Manager is responsible for managing ... network adequacy for the aligned market, tracking performance guarantees, project...and maintaining harmonious working relationships with assigned providers; managing provider agreement negotiation operations; managing staff including but not… more
- Prime Therapeutics (Atlanta, GA)
- … network reporting for Prime and vendor's pharmacy networks composition to assess network adequacy , contracting gaps and compliance with regulations + ... Network Management policies + Create and manage network contracting campaigns with network ...achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to… more
- Molina Healthcare (Syracuse, NY)
- **Job Description** **Job Summary** Molina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with ... contracting /re- contracting of standard deals, maintaining network adequacy , issue escalations and JOCs on...Director in the negotiation of medical group/IPA and hospital contracting . * Advises Network Provider … more
- Molina Healthcare (Dallas, TX)
- **Job Description** **Job Summary** Molina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with ... all claims and provider databases. Responsible for contracting /re- contracting of standard deals, maintaining network... contracting /re- contracting of standard deals, maintaining network adequacy , issue escalations and JOCs on… more
- Molina Healthcare (Long Beach, CA)
- …and must live in California _** **Job Description** **Job Summary** Molina Health Plan Provider Network Contracting jobs are responsible for the network ... contracting /re- contracting of standard deals, maintaining network adequacy , issue escalations and JOCs on...negotiating with providers. * Participates in the evaluation of provider network and implementation of strategic plans… more
- CVS Health (TX)
- …move the providers though contracting processes in order to ensure meeting network adequacy requirements. This position can sit anywhere in the United ... States.** **Required Qualifications** * 5+ years of network contracting /management experience. * Ability to travel as needed (up to 25% travel) * 5 years of… more
- CareFirst (Baltimore, MD)
- …teams within Health Services to identify and address gaps in accessibility and network adequacy through recruitment and contracting . Ensures a balanced ... (KSAs)** + Understanding of multiple reimbursement methodologies used in healthcare provider contracting , including third party payment methodologies, delegated… more
- AmeriHealth Caritas (Manchester, NH)
- …provider network to meet member needs and ensure network adequacy . + Oversee provider contracting processes, ensuring compliance with pricing ... As the Manager of Provider Network , you will build and...minimum of 3 years of experience in managed care provider contracting and reimbursement is required, including… more
- Point32Health (ME)
- …Develop and maintain optimal provider networks. Assess, monitor, and manage network adequacy to meet federal and state regulations. Proactively identify and ... Responsibilities/Duties - what you will be doing (top five): Provider Network Strategy and Development + Develop...network gaps. + Collaborate with Enterprise Allied Health Contracting to ensure allied health and BH/SA networks and… more
- Molina Healthcare (GA)
- … Services. **PREFERRED EDUCATION:** Master's Degree **PREFERRED EXPERIENCE:** 6+ years in Provider Network contracting To all current Molina employees: ... develop and implement standardized provider contracts and contracting strategies. * Monitors and reports network adequacy to leadership for all lines of… more
- CVS Health (Workman, MN)
- …with internal and external stakeholders. + 3-5 years of experience in provider contracting . + Comprehensive understanding of Ohio's healthcare landscape. + ... strategic responses. + Design and implement systems to recruit providers, supporting network expansion and adequacy goals. + Conduct competitive analyses to… more
- AmeriHealth Caritas (Detroit, MI)
- …operations of the Network Management department, including staff supervision, provider contracting , recruitment, and compliance. This role ensures the ... ** Provider Recruitment, Retention, & Relations** + Ensure network adequacy in accordance with state and...or healthcare setting. + 3 to 5 years of provider contracting and reimbursement experience. + 3… more
- Molina Healthcare (GA)
- …Network Management and Operations jobs are responsible for network development, network adequacy and provider training and education, in alignment ... relationship and management. They are responsible for provider contracting , provider training, network management and ensuring knowledge of and… more
- Elevance Health (Overland Park, KS)
- …assist management in network development planning to include gap fill projects and network adequacy reporting + May provide work direction and establish ... promoting a dynamic and adaptable workplace. **Position Overview:** Develops the provider network through contract negotiations, relationship development, and… more
- CVS Health (OH)
- …**Position Summary: Candidates must reside in Ohio** This position assesses overall network composition and potential provider partners in order to identify ... assistance in problem resolution. + May be responsible for provider recruitment, contracting , or re- contracting ...may recruit providers, as needed to ensure attainment of network expansion and adequacy targets. + Assists… more
- AmeriHealth Caritas (Baton Rouge, LA)
- **Role Overview:;** The Provider Network Account Executive II (AE II) strategically manages and develops provider networks across various healthcare ... Recruit providers as needed to ensure the realization of network adequacy targets. + Initiates and maintains...the knowledge of Plan policies and procedures related to provider contracting , provider credentialing, … more
- AmeriHealth Caritas (Raleigh, NC)
- …to support local market strategy + Recruit providers to meet network adequacy targets + Resolve complex provider service complaints and negotiate solutions + ... **Role Overview:** The Provider Network Account Executive (AE II)...materials, and train new AEs + Support of Value-Based Contracting (VBC) negotiations; lead in VBC relationships; may lead… more
- AmeriHealth Caritas (Greensboro, NC)
- …to support local market strategy + Recruit providers to meet network adequacy targets + Resolve complex provider service complaints and negotiate solutions + ... **Role Overview:** The Provider Network Account Executive (AE II)...materials, and train new AEs + Support of Value-Based Contracting (VBC) negotiations; lead in VBC relationships; may lead… more
- Pacific Medical Centers (Renton, WA)
- …regarding network and utilization issues. Responsible for a key role in provider contracting and network relations. Providence caregivers are not simply ... and maintenance of the Network Plan the provider handbook, for evaluation of the adequacy ...focus on delivering our mission to advocate, educate and provide . **About Providence** At Providence, our strength lies in… more
- Molina Healthcare (Jackson, MS)
- …and must live in Mississippi _** **Job Description** **Job Summary** Molina Health Plan Provider Network Contracting jobs are responsible for the network ... an equivalent combination of education and experience **PREFERRED EXPERIENCE** : 3+ years in Provider Network contracting To all current Molina employees: If… more