- AmeriHealth Caritas (Charleston, SC)
- …reimbursement set up. + Ensure that provider payment issues submitted by Provider Network Management or any other source are validated, researched and ... job is to be responsible for the maintaining current provider data and provider reimbursement set up,...healthcare claims payment configuration process/systems and its relevance/impact on network operations . + 1 to 2 years… more
- Humana (Little Rock, AR)
- …Pricer Business and System Support team responsible for administering complex Medicaid provider reimbursement methodologies. The associate will support existing ... be primarily responsible for implementation, maintenance and support of Medicaid provider reimbursement for hospitals and facilities....closely with IT, the pricing software vendor, CIS BSS, Medicaid operations , claims operations , and… more
- CVS Health (Chicago, IL)
- …benefits and/or contract interpretation * Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes ... Drives the implementation of internal and external solutions to achieve provider satisfaction, cost targets, utilization/performance, network growth, and… more
- CVS Health (Trenton, NJ)
- …others at all levels + Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and ... State requirements. + Evaluates, helps formulate, and implements the provider network strategic plans to achieve value-based...Network Value Based Contacting experience with 2-3 years Medicaid Network experience + Must have Microsoft… more
- Humana (Baton Rouge, LA)
- …of how organization capabilities interrelate across segments and/or enterprise-wide. The Medicaid Regional VP, Health Services will provide medical leadership ... cases (acute care hospital, LTAC, Acute rehab, SNF) according to the Humana Medicaid Model of Care. *Participate in Quality Operations including chair Quality… 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...maintaining strategic relationships within the assigned state, the care provider partners, key vendors, and the community at-large. The… more
- Humana (Baton Rouge, LA)
- …to produce requested or required data elements. This role will support our Medicaid Clinical operations in multiple markets. This role manages recurring ... **Become a part of our caring community and help us put health first** The Medicaid Data and Reporting Analyst integrates data from multiple sources… more
- Elevance Health (Indianapolis, IN)
- …Serves as a clinical pharmacy resource to pharmacy benefit management and pharmacy operations teams. + Ensures compliance of the Medicaid formularies with ... ** Medicaid Formulary Pharmacist Clinical - CarelonRx** **Location:** This...management processes. + Responsible for all member, stakeholder, and provider communications regarding formulary changes. + Ensures appropriate formulary… more
- Molina Healthcare (ID)
- …trends or other issues related to medical care costs. + Work with clinical, provider network and other personnel to bring supplemental context/insight to data ... on developing financial models to evaluate the impact of provider reimbursement changes + Provide data driven... data driven analytics to Finance, Claims, Medical Management, Network , and other departments to enable critical decision making… more
- AmeriHealth Caritas (Detroit, MI)
- **Role Overview:** ;The Provider Network Operations Data Analyst plays a key role in maintaining accurate provider data and fostering strong ... across Medicaid , Medicare, and Exchange products. This role ensures provider information is correctly represented in all operating systems and serves as… more
- AmeriHealth Caritas (Washington, DC)
- …satisfaction, education, and communication. This position is also responsible for all provider network recruiting and contracting management activities as it ... provider contracts. + Responsible for implementation of electronic strategies for provider network to include increasing electronic claims submission and… more
- Commonwealth Care Alliance (Boston, MA)
- …of health (SDOH) measures. The Program Manager will work collaboratively with our provider network and Quality teams to identify quality metrics that align ... improvement. + Analyze CAHPS results to identify trends and collaborate with Provider Network , Clinical and Quality teams to address performance gaps.… more
- Manulife (Boston, MA)
- …long-term care providers to our customers when they need it. The Director, Provider Network Development & Relationship Management, is responsible for leading the ... development, optimization, and strategic oversight of our provider network . This role is responsible for ensuring network adequacy, driving value, and… more
- CVS Health (Tallahassee, FL)
- …objectives. **Required Qualifications** + 10+ years of healthcare experience, preferably working with network and provider related operations and strategy. + ... it all with heart, each and every day. **Position Summary** The Lead Director, Provider Portal Strategy & Operations is responsible for the strategic leadership… more
- Humana (Overland Park, KS)
- … practice leveraging clinical resources. + Provide leadership to regional provider engagement, contracting, and operations teams. + Ensure regional ... the health of the communities we serve. The Regional Vice President will also provide executive leadership to Provider Contracting, Provider Education and … more
- Commonwealth Care Alliance (Boston, MA)
- …contracting, quality, compliance, medical management, and analytics teams to advance provider network operations , education, and performance improvement. ... internal and regulatory benchmarks. * Ensure provider network compliance with CMS, state Medicaid agency,...(DSNP) populations preferred. * 10+ years of experience in provider relations, contracting, or network operations… more
- Humana (Oklahoma City, OK)
- …management for network providers in Humana's Healthy Horizons in Oklahoma's Medicaid Plan, including provider onboarding, training, education, responding to ... provider experience with Humana Healthy Horizons and promote network retention + Meet regularly, both in person and...to provide the Perfect Experience in all provider interactions with Humana's Oklahoma Medicaid plan… more
- WellSense (MA)
- …taking the lead and promoting collaboration within Plan, as it relates to provider network maintenance. Manages territory inclusive of one or more of ... + **Analyzes operational issues with regard to territory and provider operations such that interrelationships among other...+ **4 or more year's progressively responsible experience in provider relations or network management required** +… more
- Commonwealth Care Alliance (Boston, MA)
- …+ Facilitate Communications Team in content creation as the subject matter expert for provider network + Maintain inventory of all provider communications ... newsletters are compliant, uniform to CCA brand standards, and provider -friendly + Work with provider network...projects and meeting deadlines. + Strong understanding of Medicare, Medicaid , duals program, and health plan operations ,… more
- Humana (Springfield, IL)
- …providers, facilities, ancillary providers, and/or FQHCs. + Experience working with Illinois Medicaid . + Experience in provider operations , building strong ... (LTSS) who are responsible for day-to-day, front-line relationship management for network providers in Humana. This role supports provider onboarding,… more