- Cardinal Health (Santa Fe, NM)
- …(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
- Molina Healthcare (Albuquerque, NM)
- …SKILLS & ABILITIES** : * 7+ years experience in Healthcare Administration, Managed Care , Provider Contracting and/or Provider Services, including ... **Job Description** **Job Summary** Molina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with respect to… more
- Molina Healthcare (Roswell, NM)
- …QUALIFICATIONS:** + At least 8 years of experience in Healthcare Administration, Managed Care , and/or Provider Network Management and Operations with an ... subject matter expertise for the design and implementation of value-based care programs across Medicaid, Medicare, and Marketplace populations, ensuring alignment… more
- Molina Healthcare (Santa Fe, NM)
- …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 (Santa Fe, NM)
- …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
- Molina Healthcare (Albuquerque, NM)
- …+ 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 (Santa Fe, NM)
- …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 (Las Cruces, NM)
- …in health care field including, but not limited to, provider's office, managed care , or other health care field. **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS ... **Job Description** **Job Summary** Molina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with respect to… more
- Molina Healthcare (Santa Fe, NM)
- …in the health care field including, but not limited to, provider's office, managed care organization, or other health care environment. * 3+ years ... in negotiating different provider contract types, ie physician, group and hospital contracting , etc. * Working familiarity with various managed healthcare… more
- Molina Healthcare (Rio Rancho, NM)
- …practice. + 5 years in a Medical Director role. + 4 years HMO/ Managed Care experience, including Utilization and/or Quality Program management. + 5 years ... managed care administrative experience to include NCQA...relevant experience + Peer Review, medical policy/procedure development, provider contracting experience. + Preferred License, Certification, Association + Active… more