- Molina Healthcare (Lexington, KY)
- …and ensure adherence to business, system and regulatory requirements of Provider Data Management / Network Adequacy. **Knowledge/Skills/Abilities** + ... among multiple systems to ensure accurate reporting of the Provider Network across the enterprise. Validate data...Integrates work with other teams including New Markets team, Network Management , Product Teams, PDM and IT.… more
- Molina Healthcare (Lexington, KY)
- …and system requirements of customers as it pertains to contracting, network management and credentialing. + **Knowledge/Skills/Abilities** + Strategically plans, ... **Job Description** **Job Summary** The Network Solutions Director is responsible for...solutions utilizing provider data such as the Provider Online Directory, Utilization Management , Customer Experience,… more
- Molina Healthcare (Lexington, KY)
- …and system requirements of customers as it pertains to contracting, network management and credentialing. **Knowledge/Skills/Abilities** * Strategically plans, ... in developing and implementing appropriate Corrective Action Plans for submission of provider network files, etc. * Engages with IT and other departments to… more
- Molina Healthcare (Lexington, KY)
- … and senior leadership/ management . * Communicates new strategies to corporate provider network leadership for input. * Utilize standardized system(s) to ... Georgia _** **Job Description** **Job Summary** Molina Health Plan Provider Network Contracting jobs are responsible for...including VBP program templates. Works with Legal and Corporate Network Management as needed to modify contract… more
- CVS Health (Frankfort, KY)
- …+ ** Provider and Vendor Management :** The Pharmacy Director collaborates with pharmacy network providers, including retail pharmacies, mail-order ... to establish a competitive advantage for the health plan. + **Pharmacy Benefit Management :** The Pharmacy Director is responsible for managing the pharmacy… more
- CommonSpirit Health (Lexington, KY)
- …Bachelor's Degree - equivalent education and experience in payer strategy, managed care or provider network senior level role may be considered in lieu of degree ... a strong preference for someone in the KY or TN area. The Market Director , Payer Strategy and Relationships (PSR), is responsible for managed care policies, goals… more
- Molina Healthcare (Lexington, KY)
- **Job Description** **Job Summary** Molina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with ... business and system requirements of customers as it pertains to contracting, network management and credentialing. **Job Duties** This role negotiates assigned… more
- Molina Healthcare (Lexington, KY)
- …as meeting or exceeding productivity standards. Educates and interacts with network and group providers and medical managers regarding utilization practices, ... guideline usage, pharmacy utilization and effective resource management . + Develops and implements a Utilization ...(QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to… more
- Molina Healthcare (Lexington, KY)
- …as meeting or exceeding productivity standards. Educates and interacts with network and group providers and medical managers regarding utilization practices, ... guideline usage, pharmacy utilization and effective resource management . + Develops and implements a Utilization ...(QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to… more
- CommonSpirit Health at Home (Lexington, KY)
- …and Responsibilities** VNA Health at Home is part of an expansive health care network that is committed to providing better patient care, with better outcomes, where ... mission of delivering hope and healing to those we serve. The Director , Clinical Services is responsible for the planning, direction, coordination, supervision,… more
- Molina Healthcare (Lexington, KY)
- …+ Maintains contractual relationships with significant/highly visible providers. + Advises Network Provider Contract Coordinators and Specialists on negotiation ... provider and routine ancillary contracts. + Evaluates provider network and implement strategic plans with...models. Seeks input on new reimbursement models from Corporate Network Management and legal. + Educates internal… more
- Sedgwick (Lexington, KY)
- …clients, customer satisfaction, revenue growth, client surveys, and new business; to provide managed care program management for jumbo clients requiring ... Work(R) Fortune Best Workplaces in Financial Services & Insurance Director - Client Services (REMOTE) Are you looking for...excellence and customer service. + Leverage Sedgwick's broad, global network of experts to both learn from and to… more
- Molina Healthcare (Lexington, KY)
- **Job Description** **Job Summary** Molina Health Plan Provider Network Management and Operations jobs are responsible for network development, ... Strategy and Services. **Job Duties** + Lead Program Director team, managing all aspects of team's mission and...Responsible for the continued development and enhancement of the Provider Network Management and Operations… 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
- Fresenius Medical Center (Georgetown, KY)
- …statements with Director + Responsible for participating in all required Network reporting and on-site state or federal surveys. + Participates in the completion ... for unexcused and missed treatments in collaboration with the Director . + Plans, coordinates and acts as the liaison...performance management , and decision making. + Demonstrated management skills necessary to provide leadership in… more
- Danaher Corporation (Lexington, KY)
- …initiatives. This role plays a pivotal part in supporting funnel management , activity tracking, and large account planning initiatives, while partnering with ... the North America Commercial Sales Enablement team and report to the Senior Director , North America Sales Enablement responsible for CRM, CPQ, and sales enablement… more
- Catholic Health Initiatives (Lexington, KY)
- …requirements ESSENTIAL KEY JOB RESPONSIBILITIES 1. Participates in the evaluation and management of diseases and health conditions in collaboration with other health ... pharmaceutical agents as outline in the approved collaborative drug therapy management agreement including initiating, adjusting, and discontinuing drug therapy 3.… more