- Battelle Memorial Institute (Columbus, OH)
- …technical leader interfaces are the program managers, contracts, finance, quality, operations , suppliers, and our customers. This engineering leadership position is ... has a thorough knowledge of contractual issues relative to the program being managed relevant to scope of the work, scheduling and subcontracts. Advises contract… more
- Molina Healthcare (Columbus, 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 (Columbus, OH)
- …Qualifications** + At least 6 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent ... + Provides status and updates to health plan/product team partners, senior management and stakeholders. + Communicates requirement interpretations and changes to… more
- Molina Healthcare (Columbus, 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 (Columbus, OH)
- …+ Proven experience handling provider disputes, appeals, and overpayment recoveries in a managed care or payer environment. + In-depth knowledge of medical and ... **JOB DESCRIPTION** **Job Summary** Provides senior level support for accurate and timely intake...4 years of experience in previous roles in a managed care organization, health insurance or directly… more
- Humana (Columbus, OH)
- …+ Bachelor's Degree. + Three (3) or more years of experience in managed care operations , provider reimbursement and analytics and/or value-based ... reporting, and scorecard/reconciliation reporting. + Understanding of Medicaid and/or Medicaid managed care . + Ability to understand and analyze financial,… more
- Humana (Columbus, OH)
- …in claims analysis, payment integrity, or healthcare data analytics, preferably within a managed care or payer environment. + Advanced proficiency in data mining ... caring community and help us put health first** The Senior Payment Integrity Professional uses technology and data mining,...payment integrity. + Familiarity with audit processes and recovery operations in a payer environment. + Experience in a… more
- Datavant (Columbus, OH)
- …sciences companies, government agencies, and those who deliver and pay for care . By joining Datavant today, you're stepping onto a high-performing, values-driven ... realize our bold vision for healthcare. **Job Summary** The Senior Manager, Facilities at Datavant will lead all aspects...Facilities at Datavant will lead all aspects of facilities operations across our locations around the world, ensuring safe,… more
- Molina Healthcare (Columbus, 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
- Western Digital (Columbus, OH)
- …needs * Facilitate technical requirements and maintain well-defined roadmaps with senior stakeholders **Legal Technology Leadership** * Serve as in-house expert on ... Change Management** * Continuously identify automation and innovation opportunities in legal operations * Track system usage, impact, and satisfaction metrics * Lead… more
- Highmark Health (Columbus, OH)
- …auditing, investigations, regulatory accreditation, process improvement, project management and/or managed care operations **Knowledge, Skills and ... and policies and regulatory bodies; performing and providing oversight of the care management delegation functions of multiple vendors through review of annual… more
- Molina Healthcare (Columbus, 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
- Centene Corporation (Columbus, OH)
- …**Education/Experience:** Current state RN license preferred. Previous experience in a managed care organization strongly preferred. 3+ years of leadership ... The Vice President of Population Health & Health Outcomes is a senior leadership role responsible for developing and executing strategies that drive measurable… more
- Prime Therapeutics (Columbus, OH)
- …performance indicator (KPI) metrics; track and report on performance; provide reporting to senior management on operations and the state of corporate enterprise ... purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven...**Job Posting Title** IT Manager - Cybersecurity Engineering & Operations - Remote **Job Description** The IT Security Manager… more
- Cardinal Health (Columbus, OH)
- …strategic C-suite and senior executive leadership partnerships with payers and managed care organizations + Comprehensive understanding of the evolving ... covering both strategic hunting and complex account management with payers and managed care organizations. By combining rigorous performance management with… more
- Cardinal Health (Columbus, OH)
- …and managing strategic relationships with C-suite payor executives as well as managed care clinical/network management/ operations leaders + Full cycle ... OH. The _Director of Business Development, Market Access_ is a seasoned managed care executive and strategic individual contributor responsible for developing… more
- Molina Healthcare (Columbus, OH)
- …health care vendor, commercial health insurance, large physician practice, managed care organization, etc.) * Advanced proficiency with retrieving specified ... BI, and/or Tableau and data management. * Advanced understanding health care operations (utilization management, disease management, HEDIS quality measures,… more
- Prime Therapeutics (Columbus, OH)
- …as HIPAA, Anti-Kickback Statute, and False Claims Act, with a focus on PBM and managed care operations + Experience engaging with regulatory bodies (eg, CMS, ... company's brand and business + Provide strategic advice to senior leaders on the most complex legal scenarios +...of experience as an attorney and 5 years representing managed care companies, health care … more
- Highmark Health (Columbus, OH)
- …Doctor of Pharmacy degree + Active pharmacist license + 4 years of experience in managed care pharmacy + 2 years of clinical account management experience in ... based pharmacy trend management discussions with internal partners including senior executives. + Support contractual pharmacy-based risk-sharing arrangements, and...Medicare as part of the 4 year managed care experience + 2 years of… more
- Evolent (Columbus, OH)
- …and proficiency + Personally initiate and foster executive level relationships at managed care organizations or health systems and large provider groups ... sales with long cycles requiring diverse stakeholder management + Knowledge of the managed care and provider markets (both payers and risk-bearing organizations)… more
