- Molina Healthcare (Cleveland, OH)
- …payment integrity and other cost recovery processes + Direct PM experience in Managed Care Operations (claims, system configuration, provider data management ... + 3-5 years in Managed Care with emphasis on Managed Care Operations **Preferred License, Certification, Association** + PMP, CAPM, PMI-ACP, PMI-PBA… more
- Molina Healthcare (Cleveland, OH)
- …+ 3 - 5 years customer service, provider service, or claims experience in a managed care setting. + 3-5 years' experience in managed healthcare ... DESCRIPTION** **Job Summary** Molina Health Plan Provider Network Management and Operations jobs are responsible for network development, network adequacy and… more
- Molina Healthcare (Cleveland, OH)
- …analysis and transformation, specifically in processing healthcare claims data and supporting managed care reporting needs + Experience using **Power BI** for ... role supporting **utilization management, population health, or quality improvement within a Managed Care Organization (MCO)** + Experience working directly with… more
- Molina Healthcare (Cleveland, OH)
- …or equivalent combination of education and experience **Required Experience** + 3-5 years managed care experience, including 2+ years in Provider Claims and/or ... level (or higher) **Preferred Education** Bachelor's Degree **Preferred Experience** + 5+ years managed care experience + QNXT; SQL experience + Crystal Reports… more
- Sherwin-Williams (Cleveland, OH)
- ABOUT THE ROLE: + The Senior Database Engineer role designs and develops robust and reliable database management systems that are secure, reliable, meet the ... technical platforms using modern tooling, build systems and processes for operations and maintenance that facilitate production needs and speed application… more
- Molina Healthcare (Cleveland, OH)
- …**Required Experience** + 5-7 years of business analysis experience, + 6+ years managed care experience. + Demonstrates proficiency in a variety of concepts, ... with multiple types of business data. May be internal operations -focused or external client-focused. **KNOWLEDGE/SKILLS/ABILITIES** + Elicit requirements using… more
- Molina Healthcare (Cleveland, OH)
- …in billing, claims, encounters, and data analysis + 5 years or more of managed care experience + Knowledge of advanced data analysis techniques + Skilled ... with preparing portions of materials and information for Monthly Governance and Operations Reviews + Performs root cause analysis of claims and encounter data… more
- Molina Healthcare (Cleveland, OH)
- …SKILLS & ABILITIES** : * 7+ years experience in Healthcare Administration, Managed Care , Provider Contracting and/or Provider Services, including 2+ years ... activities for the state health plan. Works with direct management, senior leadership/management, Corporate, and staff to develop and implement standardized provider… more
- Molina Healthcare (Cleveland, OH)
- …**Required Experience** + 10+ years progressive experience in Healthcare Administration, Managed Care and/or Provider Services. + Experience managing employees. ... activities of the State Plan's Provider Network Management and Operations Department. Works with staff and senior ...related field. **Preferred Experience** Experience with Medicaid and Medicare managed care plans. \#PJHPO \#LI-AC1 To all… more
- PNC (Brecksville, OH)
- …Manager Lead you will have an exciting opportunity to work as a senior Data & Transformation lead within Retail Lending Card Modernization organization. In this ... * Provide oversight to ensure legacy coexistence and phased adoption are managed with minimal disruption * Communicate adoption progress, risks and business value… more
- Molina Healthcare (Cleveland, OH)
- …years clinical systems experience, preferably as a product owner / manager within a managed care , nursing informatics or health care environment, or ... care management, long-term services and supports (LTSS), clinical operations and business processes. Considers business problems "end-to-end": including people,… more
- PNC (Cleveland, OH)
- …that impacts how digital information is processed and working capital is managed . As a leader in digital payment transformation, PNC Treasury Management (TM) ... their organization. The Treasury Management platform helps clients optimize their financial operations by: + Offering a robust set of traditional and emerging… more
- Molina Healthcare (Cleveland, OH)
- …Qualifications** **REQUIRED QUALIFICATIONS:** + At least 10 years' experience in Managed Care , specifically government programs and/or Medicare/Duals Health Plan ... and market leadership on mutual growth opportunities. + Works with senior management to mitigate risk and develop/implement improvements for all operational… more
- Molina Healthcare (Cleveland, OH)
- …Qualifications** **REQUIRED QUALIFICATIONS:** + At least 10 years' experience in Managed Care , specifically government programs and/or Medicare/Duals Health Plan ... provide oversight, including service level agreements. + Works with staff and senior management to mitigate risk and develop/implement improvements across areas that… more
- The Cigna Group (Cleveland, OH)
- …+ Intimate understanding and experience with larger, more complex integrated delivery systems, managed care , and provider business models. + Team player with ... with matrix partners including but not limited to, Claims Operations , Medical Management. Credentialing, Legal, Medical Economics, Compliance, Sales and… more
- The Cigna Group (Cleveland, OH)
- …relationships with provider partners. + Intimate understanding and experience with hospital, managed care , and provider business models. + Team player with ... of the Provider Contracting Team and reports to the Provider Contracting Senior Manager. This role assists in developing the strategic direction and management… more
- Stanley Black and Decker (Valley City, OH)
- …sense of purpose and integrity. People with a relentless pursuit of excellence. People who care about making things better For Those Who Make The World (TM) . Sound ... important information. Product Management also manages resource planning and works with operations and engineering to drive Design To Value (DTV), productivity and… more