- Molina Healthcare (Houston, TX)
- …Provider Services activities for the state health plan. Works with direct management , corporate, and staff to develop and implement standardized provider servicing ... and relationship management plans. **Job Duties** Manages the Plan's Provider Relations...when providers have issues or complaints (eg, problems with claims and encounter data, eligibility, reimbursement, and provider website).… more
- Path Construction (Austin, TX)
- …of the mechanics of construction and estimating along with good management and communication skills are important characteristics this candidate will possess. ... teams within our industry. Duties for Division Managers include: Regional Team Management : + Development and implementation of regional business plan for growth and… more
- The Cigna Group (Plano, TX)
- …Understanding of managed care business processes, data, systems, and applications for claims payment, enrollment, benefit design, and utilization management + ... unit cost and competitive discount. You will partner with contracting, network management , and pricing business units to deliver contract analysis results in line… more
- Kiewit (Dallas, TX)
- …using pre-defined metrics (Ex: progress of projects, financial health, schedule adherence, risk and opportunities, claims ). * Work closely with "Get Work" ... with tenant improvements. Its capabilities include general construction, construction management , design-build, design-assist and turn-key project development. Kiewit also… more
- Highmark Health (Austin, TX)
- …terms through regular on-site audits. Apply an active role in network management , training, monitoring and enforcement of company policies and procedures while ... ensure they utilize various means of automated communication, as well as, claims and electronic data interchange and electronic funds transfer. Collaborate with… more
- Molina Healthcare (San Antonio, TX)
- …quality improvement** + Experience working directly with **clinicians, nurses, or case management teams** + Familiarity with risk adjustment, value-based care ... into technical solutions. This role works closely with clinicians, care management teams, and business stakeholders to gather requirements and deliver actionable… more
- Adecco US, Inc. (Houston, TX)
- …to HIPAA regulations, and organizational policies always. . Utilize prescription claims data to generate clinical recommendations according to Medication Therapy ... Management and Retrospective Drug Utilization Review program protocols providing...to, but not limited to, gaps in care, high risk medications, compliance and adherence, drug interactions, therapeutic substitution,… more
- Mass Markets (TX)
- …Temporary and Administrative Professional Staffing (TAPS Schedule 736), Business Process Management (BPM), Business Process Outsourcing (BPO), Claims Processing, ... of robust controls and budgeting systems. The goal is to minimize risk , ensure the integrity of financial reporting, and maintain compliance with generally… more
- Wolters Kluwer (Houston, TX)
- …complex employee relations issues, policy interpretation, conflict resolution, and performance management . To support the centralized team model, you will also ... matters that are raised internally, EEOC and DOL charges, state agency claims , hotline complaints. In collaboration with the Global Compliance & Legal Department… more
- Kiewit (Ingleside, TX)
- …using pre-defined metrics (Ex: progress of projects, financial health, schedule adherence, risk and opportunities, claims ). * Work closely with "Get Work" ... with tenant improvements. Its capabilities include general construction, construction management , design-build, design-assist and turn-key project development. Kiewit also… more