- Valvoline Global (Lexington, KY)
- …better future. With a global presence, we develop **future-ready products** and provide **best-in-class services** for our partners around the world. For us, ... oversight of executive protection, facility security, global travel risk management , regulatory compliance, crisis response, and security technology integration. The… more
- Magnolia Medical Technologies, Inc. (Lexington, KY)
- …criteria to ensure customer acquisition and retention bringing the account under management Partner with Magnolia Medical's Business Director (BD) team to ... sales operations and related processes within the territory including CRM management (salesforce.com), sales activity and account documentation, data collection… more
- Molina Healthcare (Lexington, KY)
- …design solutions utilizing provider data such as the Provider Online Directory, Utilization Management , Customer Experience, Enrollment, and Claims ... **Job Description** **Job Summary** The Network Solutions Director is responsible for leading a team designing...combination of education and experience **Required Experience** 7-9 years Provider Data **Preferred Education** Graduate Degree or… more
- Molina Healthcare (Lexington, KY)
- … Information process functions. * Directs the development, implementation and maintenance of provider data in the claims payment system. * Supports critical ... databases. Maintains critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems and application of… more
- Molina Healthcare (Lexington, KY)
- …optimization, and service delivery + Overseeing implementation of scalable solutions for provider onboarding, data management , and credentialing operations + ... **JOB DESCRIPTION** **Job Summary** Lead operational readiness initiatives across provider data and credentialing functions, supporting both new implementations… more
- Molina Healthcare (Lexington, KY)
- …and ensure adherence to business, system and regulatory requirements of Provider Data Management /Network Adequacy. **Knowledge/Skills/Abilities** + ... work with other teams including New Markets team, Network Management , Product Teams, PDM and IT. **Job Qualifications** **REQUIRED...EXPERIENCE:** + Advanced Excel skills. + Power BI. + Provider Data Analytics. To all current Molina… more
- Molina Healthcare (Lexington, KY)
- **Job Description** **Job Summary** The Director , Clinical Data Acquisition for Risk Adjustment, is responsible for the implementation, monitoring, and oversight ... and data completeness training, onboarding for CDA team members, vendor management for chart collection vendors, Supplemental data , and chart collection… more
- CVS Health (Frankfort, KY)
- …Review (DUR) and formulary/guideline changes. + ** Provider and Vendor Management :** The Pharmacy Director collaborates with pharmacy network providers, ... to establish a competitive advantage for the health plan. + **Pharmacy Benefit Management :** The Pharmacy Director is responsible for managing the pharmacy… more
- CVS Health (Frankfort, KY)
- …of provider performance improvement initiatives + Establish a program management framework for VBC improvement initiatives-- monitoring the impact of efforts and ... And we do it all with heart, each and every day. The Lead Director , National VBC Performance Planning & Insights will act as a strategic leader driving… more
- Molina Healthcare (Lexington, KY)
- …regarding utilization practices, guideline usage, pharmacy utilization and effective resource management . + Develops and implements a Utilization Management ... activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to Medicare, Medicaid,… more
- Molina Healthcare (Lexington, KY)
- …regarding utilization practices, guideline usage, pharmacy utilization and effective resource management . + Develops and implements a Utilization Management ... activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to Medicare, Medicaid,… more
- Molina Healthcare (Lexington, KY)
- …of value-based care models, provider enablement strategies, and population health management . + Strong knowledge of data integration, EMR systems, and ... programs focused on provider enablement, ensuring access to tools, training, and data for success in VBC models. + Design and implement VBC training programs,… more
- Molina Healthcare (Lexington, KY)
- …HMO/Managed Care experience **OR** 5 years experience as a Molina Medical Director + Demonstrated experience in Utilization/Quality Program management + Previous ... Assists in recruitment, hiring and training of staff as needed. + Analyzes data and identifies medical cost savings and quality improvement opportunities. + Accounts… more
- CommonSpirit Health at Home (Lexington, KY)
- …mission of delivering hope and healing to those we serve. The Director , Clinical Services is responsible for the planning, direction, coordination, supervision, ... & Compliance:** Uphold the Corporate Compliance Program. + **Operational Support:** Provide prompt and professional assistance to office and clinical staff. +… more
- WESCO (Lexington, KY)
- As the Senior Director - LEAN, you will be responsible for strategic leadership of operational excellence and continuous improvement efforts. You will work across ... of resources to solve problems to meet business objectives. + Utilize customer data to influence leaders to achieve positive business results. + Participate in… more
- Molina Healthcare (Lexington, KY)
- …timely maintenance of critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems when applicable, ... business rules as they apply to each database. Validate data to be housed on provider databases...Identified as contract system lead by developing and maintaining provider contracts in contract management software. *… more
- Molina Healthcare (Lexington, KY)
- …compliance program, including annual, periodic, focal, etc. audits. * Performance Management & KPI Expertise: Develop, implement, and monitor KPIs, including leading ... adherence, diagnose root causes of misses, and drive accountability across functions. * Data Insight & Decision Support: Ingest and interpret complex data from… more
- CVS Health (Frankfort, KY)
- …with business objectives. This role requires strategic oversight, data -driven decision-making, and cross-functional leadership to optimize vendor contributions ... + Oversee the collection, analysis, and reporting of vendor performance data . Create clear, actionable reports and scorecards for executive leadership and… more
- Molina Healthcare (Lexington, KY)
- …care in the most effective setting. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties * Determines ... health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies to ensure… more
- Molina Healthcare (Lexington, KY)
- …practice. * Deep understanding of clinical operations: utilization management , care management , etc. * Ability to provide hands-on, immersive and directed ... to establish strategic plans and objectives. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties * Under the… more
