- Elevance Health (Lake Mary, FL)
- ** 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 (Lake Mary, FL)
- ** 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
- Highmark Health (Pittsburgh, PA)
- …organizational strategy. + Support market expansion and program activities by leading provider contract analysis and network development related to due ... networks across expansion markets. Performs periodic analyses of the provider network from a cost , coverage, and...data and/or market information to derive conclusions to support contract negotiations. Conducts periodic review of provider … more
- CVS Health (Hartford, CT)
- …professionals. We are seeking a **Manager - Aetna Claim Adjudication System (ACAS) Provider Contract Testing** to join our Testing Center of Excellence (TCOE). ... ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we reach millions… more
- CVS Health (Hartford, CT)
- …ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we reach millions ... and a workforce of over 300,000 purpose-driven professionals. We care for people where, when, and how they choose,...and compassionate. We are seeking a **Senior Manager, Commercial Contract Testing** to join our Testing Center of Excellence… more
- UNC Health Care (Raleigh, NC)
- …healthcare team in accordance with privileges approved by the credentialing committee to provide high-quality, cost -effective care to patients within the ... guidelines and other regulatory and accreditation standards. **Join our growing UNC Urgent Care provider team! This is an employed position with UNC Rex… more
- UNC Health Care (Butner, NC)
- …healthcare team in accordance with privileges approved by the credentialing committee to provide high-quality, cost -effective care to patients within the ... problem-solving, decision-making, and evaluating clinical/system issues and models of care . Leads interdisciplinary teams to provide integrated delivery… more
- CareFirst (Baltimore, MD)
- …matter expert (SME) in contracting and reimbursement, offering insights during contract development and negotiations with smaller provider practices based ... and market analysis. + Supports negotiations, development of strategy, market and provider intelligence, and contract execution for institutional, ancillary and… more
- CareFirst (Baltimore, MD)
- …the use of provider data to draft and negotiate fixed-price and cost reimbursement care contracts. + Evaluates reimbursement inquiries and develops cost ... matter expert (SME) in contracting and reimbursement, offering insights during contract development and negotiations with large top-tier provider practices… more
- Corewell Health (Southfield, MI)
- …contracts and passion for problem solving? Priority Health is seeking a Senior Provider Contract Specialist to take ownership of affiliated network contracting. ... through execution, compliance and renewal. Provides support for management of medical cost of care and efficiency initiatives. Additionally, this position… more
- Molina Healthcare (Jackson, MS)
- …or other health care environment. * 3+ years experience in provider contract negotiations in a managed healthcare setting ideally in negotiating ... Provider Community that result in high quality, cost effective and marketable providers. Contract /Re-contracting with...5-7 years contract -related experience in the health care field including, but not limited to, provider… more
- Health Care Service Corporation (Chicago, IL)
- …of cross-functional strategic projects within Healthcare Delivery and network and value-based care program evolution, where high value provider partners are ... more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost -effective health care and equipping our members with information and tools… more
- Centene Corporation (Tallahassee, FL)
- …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
- Premera Blue Cross (Mountlake Terrace, WA)
- …knowledge, and Premera product knowledge to foster a collaborative approach to quality care , network stability and cost containment. + Develop and maintain ... and internal leadership, providing industry and cross-market expertise. Create provider specific and public presentations. + Provide ...in payer or provider contracting and managing provider relationships in the health care or… more
- Molina Healthcare (St. Clair Shores, MI)
- …Duties** This role negotiates assigned contracts and letters of agreements with non-complex provider community that result in high quality, cost effective and ... of medical group/IPA and hospital contracting. * Identified as contract system lead by developing and maintaining provider...: Bachelor's Degree or equivalent work experience in health care field including, but not limited to, provider… more
- Centene Corporation (Atlanta, GA)
- …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 (Salem, OR)
- …quality reviews of Practitioner and/or Facility/Ancillary contracts. Conducts comparison of contract data relative to provider data and/or demographic and ... + Respond to provider inquiries, concerns, complaints, appeals and grievances + Provide ongoing product education to dentists and their staff + Work to achieve … more
- AmeriHealth Caritas (Southfield, MI)
- …financial performance by identifying cost -saving opportunities, ensuring competitive provider contracts, and enhancing value-based care . + Drives member ... Degree preferred. + 10 or more years of experience years of managed care provider contracting and reimbursement experience, including in-depth knowledge of… more
- CenterWell (Phoenix, AZ)
- …for quality management/ cost and utilization / develop interventions / evaluate provider workflows / + Attend team meetings / external Meetings / shared service ... Issues / Action Items in MSO Connect (membership, payment, contract load) + Email Inbox Management + Follow-up (existing...Bachelor's Degree + 5 or more years of Health care or managed care with Provider… more
- Point32Health (Canton, MA)
- …Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and ... to understand performance, financial or otherwise, of the allied provider network. Work closely with the contract ...Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide … more