- Northwell Health (New York, NY)
- **Req Number** 173504 Job Description The AVP for Health Plan Performance will be responsible for driving the performance of our network solution across ... coordination and administration of policies, services and programs that optimize health plan performance for Northwell Direct. Collaborates with leadership… more
- City of New York (New York, NY)
- …negotiating collective bargaining agreements with the City's 149 bargaining units. 1.Monitor Health Plan Compliance: Review and audit of self-funded health ... and timeliness of daily healthcare claims payment data submitted by the health plan prior to authorize payment. Perform monthly reconciliations between the daily… more
- Molina Healthcare (Rochester, NY)
- …Summary** Provides subject matter expertise for oversight, production, and resolution of health plan payment integrity (PI) recovery concepts. Executes and ... monitors health plan scoreable action items (SAIs) to ensure performance and quality levels exist in PI Business products and processes. Establishes procedures… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- …Business Development but will work closely with the executive leadership team of Brighton Health Plan Solutions. This role will be a strategic partner and ... with an understanding of the complex healthcare landscape, including knowledge of TPA/ health plan services, network products, and employee benefits, preferred. +… more
- City of New York (New York, NY)
- …staff responsible for the reconciling of claims payments within the City's self-funded health plan effective January 1, 2026. Key Responsibilities: o Monitor ... health plan processes to ensure compliance with contractual obligations, regulatory requirements, and internal policies related to health claims and monthly… more
- Brighton Health Plan Solutions, LLC (Westbury, NY)
- …and proactive QA Analyst to support quality assurance efforts across Brighton Health Plan Solutions' core portfolios-Claims, Provider, and Enrollment. In this ... a plus. * General Knowledge of HIPAA Confidentiality Laws About At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- About the Role Brighton Health Plan Solutions (BHPS) is seeking an Eligibility Service Representative (ESR) who are experienced in understanding eligibility, ... + Some college or business school education is advantageous. About At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- …Writing samples will be requested as part of the interview process. About At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of ... your authentic self to work with all your unique abilities. Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health … more
- Brighton Health Plan Solutions, LLC (Westbury, NY)
- …to multi-task. * General Knowledge of HIPAA Confidentiality Laws About At Brighton Health Plan Solutions, LLC, our people are committed to the improvement ... your authentic self to work with all your unique abilities. Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health … more
- Elevance Health (New Hyde Park, NY)
- … Performance Medical Director** serves as the Chief Medical Officer for the health plan 's Commercial business. This individual is responsible for oversight of ... ** Plan Performance Medical Director- New York Commercial** Location:...active unrestricted medical license to practice medicine or a health profession. + Unless expressly allowed by state or… more