- Elevance Health (Richmond, VA)
- ** 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
- The Cigna Group (Richmond, VA)
- …improve total medical cost and quality. + Drives change with external provider partners by offering consultative expertise to assist with total medical cost ... + Prepares, analyzes, reviews, and projects financial impact of provider contracts and alternate contract terms. +...managing relationships + Understanding and experience with hospital, managed care , and provider business models a plus… more
- CVS Health (Richmond, VA)
- …to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information. + Negotiates settlements as needed. ... contract negotiator: + Negotiates competitive contracts with health care providers using pre-determined internal guidelines and financial standards. + Negotiates… more
- The Cigna Group (Richmond, VA)
- …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
- The Cigna Group (Richmond, VA)
- …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
- Humana (Richmond, VA)
- …extensive business leadership experience, with several years in a managed care environment leading a network development/ provider relations function, including ... seeking an accomplished healthcare leader for the position of Vice President, National Provider Network Management. At a high level, this highly visible role will be… more
- Humana (Richmond, VA)
- … efficiency, and population health outcomes through strategic provider partnerships, data-informed decision-making, and cross-functional collaboration. The RVP ... and maintain trusted relationships with CMOs and senior executive/clinical leaders at provider and care delivery partner organizations. First and foremost, this… more
- CVS Health (Richmond, VA)
- …activities. Drives the implementation of internal and external solutions to achieve provider satisfaction, cost targets, network growth, and efficiency targets. ... for escalated issues related to claims payment, policies, accuracy of provider demographic information and contract interpretation. + Educates providers… more
- Intermountain Health (Richmond, VA)
- …invoice to the contract . Participates as needed with authorized service provider contract negotiations. Provides notification to appropriate CE personnel of ... history records to reflect the current service agreement coverage. Manages the contract lifecycle for authorized service provider agreements, to include, but… more
- Elevance Health (Richmond, VA)
- The **Behavioral Health Care Manager I - Virginia** is responsible for managing psychiatric and substance abuse or substance abuse disorder facility-based and ... needs to ensure access to medically necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract .… more
- Prime Therapeutics (Richmond, VA)
- …value to the customer, derived from identifying, demonstrating and selling valued pharmaceutical care and cost solutions that meet the desired outcomes of the ... fashion. + Demonstrates the value of pharmacy solutions (unit cost , utilization management & patient care enhancement)....achievements. We value new ideas and work collaboratively to provide the highest quality of care and… more
- Bon Secours Mercy Health (Mechanicsville, VA)
- At Bon Secours Mercy Health, we are dedicated to continually improving health care quality, safety and cost effectiveness. Our hospitals, care sites and ... established benchmarks including hold buckets. + Ensures scheduling of staff to promote provider productivity as well as promote quality care and fiscal… more
- CVS Health (Richmond, VA)
- …non-routine Provider Refunds and Returned Checks. + Review and interpret medical contract language using provider contracts to confirm whether a claim is ... ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we reach millions… more
- Veterans Affairs, Veterans Health Administration (Richmond, VA)
- …of clinic performance, including but not limited to: productivity, scheduling, cost efficiency, provider ongoing clinical performance reviews, staff yearly ... for a qualified and skilled Neurologist who will be responsible for direct patient care with various neurological disorders. They should be able to deliver quality … more
- CVS Health (Richmond, VA)
- … drafting; compliance and regulatory analysis; special investigations; provider relations; customer service or audit experience. **Preferred Qualifications** ... ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we reach millions… more
- Veterans Affairs, Veterans Health Administration (Richmond, VA)
- …looking for a skilled BE/BC Hematologists/Oncologist. The incumbent physician is expected to provide comprehensive patient care in the form of consultative, and ... inpatient and outpatient hematology/oncology patient care including monitoring parental and oral anti-cancer therapy administration...to grow your career. The city also boasts a cost of living that is 4.9% lower than the… more
- Evolent (Richmond, VA)
- …years of professional experience in claims-based healthcare analytics with a payer, provider , clinical vendor, managed care , or related healthcare consulting ... people with most complex and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented health care … more
- Elevance Health (Richmond, VA)
- …more complex medical transplant issues. + Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient ... member access to medically necessary, quality healthcare in a cost effective setting according to contract . +...and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management… more
- Bon Secours Mercy Health (Midlothian, VA)
- At Bon Secours Mercy Health, we are dedicated to continually improving health care quality, safety and cost effectiveness. Our hospitals, care sites and ... of all people in mind, body, and spirit through exceptional patient care . Success in this goal requires a culture of compassion, collaboration, excellence,… more
- Prime Therapeutics (Richmond, VA)
- …empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members. If ... retail, mail, specialty, and quality-based networks aligning with Prime's Supply Chain Cost of Goods Sold (COGS) and network management strategies. This includes… more