- Elevance Health (Atlanta, GA)
- ** Provider Contract / Cost of Care Consultant** **Location:** This role requires associates to be in-office 1 day per week, fostering collaboration and ... an accommodation is granted as required by law. The ** Provider Contract / Cost of Care...or any combination of education and experience, which would provide an equivalent background. **Preferred Skills, Capabilities and Experiences:**… more
- Elevance Health (Atlanta, GA)
- ** 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 (Atlanta, GA)
- …office. **Position Overview:** Provides the highest level of analytical support to the Cost of Care and/or Provider Contracting organizations. Focuses ... develop contracting strategy and supports all aspects of the contract negotiation process. Works with multiple provider ...modifications as applicable + Recommends standardized practices to optimize cost of care + Educates provider… more
- The Cigna Group (Atlanta, GA)
- **Work Location: Atlanta, GA** The **AVP, Provider Contract Network Management** serves as an integral member of the Network Management & Affordability Team and ... total medical cost and quality. + Drives change with external provider partners by assessing clinical informatics and offering consultative expertise to assist… more
- Molina Healthcare (Atlanta, GA)
- …with the Complex Provider Community that result in high quality, cost effective and marketable providers. Contract /Re-contracting with large scale entities ... cost control initiatives to positively influence the Medical Care Ratio (MCR) in each contracted region. * Leads...department and organization. * Oversees the maintenance of all Provider Contract templates including VBP program templates.… more
- The Cigna Group (Atlanta, GA)
- …total medical cost and quality. + Drives change with external provider partners by assessing clinical informatics and offering consultative expertise to assist ... reviews, and projects financial impact of larger or complex provider contracts and alternate contract terms. +...partners. + Intimate understanding and experience with hospital, managed care , and provider business models. + Team… 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
- 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
- CVS Health (Atlanta, GA)
- …Aetna's National Provider business. This role maintains and updates provider demographic and contract information, including contractually sensitive or ... 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 (Atlanta, GA)
- …ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we reach millions ... and alignment with organizational goals to ensure the delivery of exceptional provider experiences and operational excellence. This role serves as the primary… more
- Molina Healthcare (Atlanta, GA)
- …outcomes and financial performance of the product. Contributes to overarching strategy to provide quality and cost -effective member care . **ESSENTIAL JOB ... regulations. **REQUIRED QUALIFICATIONS:** + At least 12 years of experience in health care leading state Medicaid long-term care services programs in a… more
- Molina Healthcare (Atlanta, GA)
- …claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and ... cost containment reports and makes recommendations based on relevant...materials and documentation archives. + Demonstrate Healthcare experience in contract modeling, analyzing relevant Financial and Utilization Metrics of… more
- Molina Healthcare (Atlanta, GA)
- …ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost -effective member care . Essential Job ... health care concerns, uses clinical judgment to provide care management or refer members to...licensure and/or certification required ONLY if required by state contract , regulation or state board licensing mandates. If licensed,… more
- Molina Healthcare (Atlanta, GA)
- …delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost -effective member care . Essential Job Duties * ... Assesses services for members to ensure optimum outcomes, cost -effectiveness and compliance with all state/federal regulations and guidelines. * Analyzes clinical… more
- Molina Healthcare (Atlanta, GA)
- …underperforming and problematic contracts. Supports multi-dimensional pricing strategies to drive down total cost of care and minimize variation in cost by ... financial impact. * Work independently to support and validate Provider Network contracting and unit cost management...Provides peer review of team members' presentations for total cost of care and profit improvement initiatives… more
- Molina Healthcare (Atlanta, GA)
- …underperforming and problematic contracts. Supports multi-dimensional pricing strategies to drive down total cost of care and minimize variation in cost by ... financial impact. + Work independently to support and validate Provider Network contracting and unit cost management...Provides peer review of team members' presentations for total cost of care and profit improvement initiatives… more
- Highmark Health (Atlanta, GA)
- …and provider contracting or revenue management + 2 years Understanding of provider contract documents and overall contract management process **LICENSES ... a focus of innovation. + Develop and maintains strategic provider relationships to understand the current health care...of healthcare + Comfort and with real-time calculations of cost , membership, etc. (ie, "back of the envelope" estimations)… more
- Humana (Atlanta, GA)
- …. The case manager will offer guidance, support, and coordination of the beneficiary's care as directed by the beneficiary, the provider (s) or other members of ... needs of TRICARE beneficiaries, to maximize each beneficiary's capacity for self- care , to cost -effectively achieve desired clinical outcomes and to enhance… more
- Fortive Corporation (Atlanta, GA)
- …For you, for us, for growth. **About Gordian** Gordian is the world's leading provider of facility and construction cost data, software and services for all ... Gordian is the leader in facility and construction cost data, software, and services for all phases...projects, ensuring successful execution from planning through closeout. . Provide strategic oversight and support to direct reports managing… more
- Wabtec Corporation (Atlanta, GA)
- …to stakeholders and senior management, as required. + Use Clarity to manage the contract budget, cost , and revenue, to ensure the resources are available to ... customer within Wabtec. The TPM's primary objective is to provide customer-valued service as set forth in established Service...inquiries and ensure action items are closed out per Contract terms and/or to customer's satisfaction. + Work closely… more