- Cardinal Health (Frankfort, KY)
- …(ex. Blue Cross, Blue Shield, IPA, etc). Reporting to the Director of Managed Care , the Manager of Contracting is responsible for managing legal ... between payer and provider(s) to ensure optimal reimbursement including managed care contracting , enrollment, credentialing,...with strategy. **Essential Functions:** + In collaboration with the Director of Managed Care , negotiate… more
- Jennie Stuart Medical Center, Inc. (Hopkinsville, KY)
- …of Western Kentucky Healthcare System (WKHS). Develops, manages, and monitors the managed care contracting , credentialing, and provider enrollment processes. ... Works under the supervision of the Managed Care Director . Organizational Expectations...of budget preparation. Essential Functions * Functions as primary managed care contracting , credentialing and… more
- Molina Healthcare (KY)
- …guidelines. + Experience in Utilization/Quality Program management + HMO/ Managed care experience **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:** ... includes strategies that ensure a high quality of patient care , ensuring that patients receive the most appropriate ...(QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to… more
- Highmark Health (Frankfort, KY)
- …Insurance, Consulting or related area + 3 years Value-based reimbursement, through managed care contracting , provider reimbursement, consulting, population ... drive adoption and ROI realization. Critical partners include Advanced Analytics, Contracting , Market and Provider support teams, Actuary, Finance, Highmark Health… more
- Humana (Frankfort, KY)
- …Deep understanding and experience with healthcare policies and operations in a managed care setting Excellent oral and written communications skills, including ... are seeking an accomplished healthcare physician leader for the newly-created role of Director , Physician Leadership. In this role, you will be a key enterprise… more
- Molina Healthcare (KY)
- …+ 10+ years relevant experience, including 5+ years of clinical practice and 3+ years HMO/ Managed Care experience **OR** 5 years experience as a Molina Medical ... inpatient concurrent review, discharge planning, case management and interdisciplinary care team activities. + Ensures that authorization decisions are...Director + Demonstrated experience in Utilization/Quality Program management +… more
- Evolent (Frankfort, KY)
- …professional experience in claims-based healthcare analytics with a payer, provider, vendor, managed care , or related healthcare consulting entity + Extensive ... people with most complex and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented health care … more
- Molina Healthcare (Lexington, KY)
- …with appeals/grievance and/or claims processing within a managed care setting. **Preferred Education** Bachelor's degree Previous Director experience. ... with local Health Plan requirements * Works with Claims, Configuration, Contracting , Provider Data Management, and other business partners to resolve provider… more
- Prime Therapeutics (Frankfort, KY)
- …including pharmaceutical manufacturers, with specific emphasis on Medicare Part D and Managed Medicaid. The Sr Director , Pharm Trade Relations leads a ... Sr Dir Pharmacy Trade Relations - Remote **Job Description** The Sr Director , Pharmaceutical Trade Relations is responsible for managing Prime's Trade Relations… more
- Waystar (Louisville, KY)
- …Develop and maintain strong relationships with payers, including health insurance companies, managed care organizations, and government agencies. + Create new, ... and innovative payer strategies. This role will report to the Sr Director of Product Operations. **WHAT YOU'LL DO** **Payer Relationship Management:** + Identify… more
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