- Pairtu (San Francisco, CA)
- …- Have **8+ years in healthcare operations ** at a startup, clinic, or provider network . - Have **touched credentialing or payer enrollment** directly - not ... for a senior, hands-on operator who can work across credentialing, payer contracting, provider onboarding, and day-to-day ops while keeping a sharp eye on patient… more
- AmeriHealth Caritas (Charleston, SC)
- …reimbursement set up. + Ensure that provider payment issues submitted by Provider Network Management or any other source are validated, researched and ... job is to be responsible for the maintaining current provider data and provider reimbursement set up,...healthcare claims payment configuration process/systems and its relevance/impact on network operations . + 1 to 2 years… more
- CVS Health (Columbia, SC)
- …experience in Provider Operations , Provider Relations, or Network operations . + 1+ years of experience in Medicaid provider operations . + ... every day. **Position Summary** + Lead a team of Medicaid Provider Data Services Analysts responsible for...data within Aetna QNXT. + Team will also include provider operations analyst and potential pre-cred support… more
- Humana (Annapolis, MD)
- …Pricer Business and System Support team responsible for administering complex Medicaid provider reimbursement methodologies. The associate will support existing ... be primarily responsible for implementation, maintenance and support of Medicaid provider reimbursement for hospitals and facilities....closely with IT, the pricing software vendor, CIS BSS, Medicaid operations , claims operations , and… more
- CVS Health (Trenton, NJ)
- …others at all levels + Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and ... State requirements. + Evaluates, helps formulate, and implements the provider network strategic plans to achieve value-based...Network Value Based Contacting experience with 2-3 years Medicaid Network experience + Must have Microsoft… more
- Humana (Baton Rouge, LA)
- …of how organization capabilities interrelate across segments and/or enterprise-wide. The Medicaid Regional VP, Health Services will provide medical leadership ... cases (acute care hospital, LTAC, Acute rehab, SNF) according to the Humana Medicaid Model of Care. *Participate in Quality Operations including chair Quality… more
- Elevance Health (Dearborn, MI)
- …Serves as a clinical pharmacy resource to pharmacy benefit management and pharmacy operations teams. + Ensures compliance of the Medicaid formularies with ... ** Medicaid Formulary Pharmacist Clinical - CarelonRx** **Location:** This...management processes. + Responsible for all member, stakeholder, and provider communications regarding formulary changes. + Ensures appropriate formulary… more
- Molina Healthcare (ID)
- …trends or other issues related to medical care costs. + Work with clinical, provider network and other personnel to bring supplemental context/insight to data ... on developing financial models to evaluate the impact of provider reimbursement changes + Provide data driven... data driven analytics to Finance, Claims, Medical Management, Network , and other departments to enable critical decision making… more
- AmeriHealth Caritas (Charleston, SC)
- …related to healthcare claims payment configuration process/systems and its relevance/impact on network operations + Knowledge of the delivery of healthcare ... Provider billing requirements and as liaison to the Enterprise Operations Configuration Department + Participate in Provider Reimbursement medical policy… more
- AmeriHealth Caritas (Detroit, MI)
- **Role Overview:** ;The Provider Network Operations Data Analyst plays a key role in maintaining accurate provider data and fostering strong ... across Medicaid , Medicare, and Exchange products. This role ensures provider information is correctly represented in all operating systems and serves as… more
- AmeriHealth Caritas (Washington, DC)
- …satisfaction, education, and communication. This position is also responsible for all provider network recruiting and contracting management activities as it ... provider contracts. + Responsible for implementation of electronic strategies for provider network to include increasing electronic claims submission and… more
- Commonwealth Care Alliance (Boston, MA)
- …of health (SDOH) measures. The Program Manager will work collaboratively with our provider network and Quality teams to identify quality metrics that align ... improvement. + Analyze CAHPS results to identify trends and collaborate with Provider Network , Clinical and Quality teams to address performance gaps.… more
- Humana (Oklahoma City, OK)
- …management for network providers in Humana's Healthy Horizons in Oklahoma's Medicaid Plan, including provider onboarding, training, education, responding to ... provider experience with Humana Healthy Horizons and promote network retention + Meet regularly, both in person and...to provide the Perfect Experience in all provider interactions with Humana's Oklahoma Medicaid plan… more
- CVS Health (Columbus, OH)
- …objectives. **Required Qualifications** + 10+ years of healthcare experience, preferably working with network and provider related operations and strategy. + ... it all with heart, each and every day. **Position Summary** The Lead Director, Provider Portal Strategy & Operations is responsible for the strategic leadership… more
- Commonwealth Care Alliance (Boston, MA)
- …contracting, quality, compliance, medical management, and analytics teams to advance provider network operations , education, and performance improvement. ... internal and regulatory benchmarks. * Ensure provider network compliance with CMS, state Medicaid agency,...(DSNP) populations preferred. * 10+ years of experience in provider relations, contracting, or network operations… more
- WellSense (MA)
- …taking the lead and promoting collaboration within Plan, as it relates to provider network maintenance. Manages territory inclusive of one or more of ... + **Analyzes operational issues with regard to territory and provider operations such that interrelationships among other...+ **4 or more year's progressively responsible experience in provider relations or network management required** +… more
- Commonwealth Care Alliance (Boston, MA)
- …+ Facilitate Communications Team in content creation as the subject matter expert for provider network + Maintain inventory of all provider communications ... newsletters are compliant, uniform to CCA brand standards, and provider -friendly + Work with provider network...projects and meeting deadlines. + Strong understanding of Medicare, Medicaid , duals program, and health plan operations ,… more
- Humana (Springfield, IL)
- …providers, facilities, ancillary providers, and/or FQHCs. + Experience working with Illinois Medicaid . + Experience in provider operations , building strong ... (LTSS) who are responsible for day-to-day, front-line relationship management for network providers in Humana. This role supports provider onboarding,… more
- Commonwealth Care Alliance (Boston, MA)
- …problem-solving. * Represent CCA's behavioral health priorities, programs, and initiatives to the provider network . * Promote provider understanding of CCA's ... Health, Health Home, Network , and Clinical teams to ensure a seamless provider experience and consistent delivery of quality care. The BH Provider Engagement… more
- CVS Health (Columbus, OH)
- …the process for identifying, evaluating, and completing contracting with Specialty and Medicaid provider partners. . Developing relationships with leaders of ... chronic kidney, oncology, polychronic/complex care, and emerging specialty types) or Medicaid provider organizations to design and execute on strategies… more
