- Humana (Sacramento, CA)
- …performance improvement, physician engagement, informatics, network development, and contract/ payer relations. This design gives the Fellow the opportunity ... to build fundamental communication, analytic, and problem-solving skills as well as an understanding of the ACO environment and population health strategies. To complement on-the-job training, fellows are involved in Board and other administrative meetings.… more
- Datavant (Sacramento, CA)
- …and educational needs related to coding quality, compliance assessments, external payer reviews, coding education, and coding workflow operations reviews. In this ... role, you will offer meaningful information tailored to exceed customer expectations, actively identifying and presenting solutions for customer issues. This role is fully remote with a flexible schedule, allowing you to help shape the future of healthcare… more
- Kyndryl (Sacramento, CA)
- …+ Healthcare industry experience is a strong plus, especially in payer /provider operations and care management workflows. **Preferred Qualifications: ** + 15+ ... years' experience in contact center sales, consulting, services, or transformation initiatives. + Previous experience in leading healthcare-focused journey redesign from eligibility verification to care management. + Align contact center transformation with… more
- CVS Health (Sacramento, CA)
- …+ 3 to 5 years Industry experience in mental or behavioral health, payer , commercial, and Medicare + Proven ability to interact with, influence and collaborate ... with business leaders and producing managers at all levels + PMP certification + Experience with enterprise-wide and/or cross-functional large-scale initiatives with high degree of complexity **Education** + Bachelor's degree or equivalent professional work… more
- Sharp HealthCare (San Diego, CA)
- …on site of care. + ContractingCollaborates with Contract's team to evaluate on-going Payer contract changes that may have implications to drug reimbursement and net ... revenue, across all ambulatory care settings.Assists Contract's team with DOFR contracting related to drug utilization for medical groups and hospitals.Negotiates pharmaceutical contracts for high cost and high use medications to assist with formulary… more
- Molina Healthcare (Riverside, CA)
- …models in concert with Director. * Oversees the maintenance of all Provider and payer Contract Templates. Works with legal and Corporate Network Management on an as ... needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements. * Ensures compliance with applicable provider panel and network capacity, adequacy requirements and guidelines. Produces and monitors… more
- Evolent (Sacramento, CA)
- …key performance indicators + Partner with Evolent Strategic Account teams and payer clients to align priorities and deliver high-quality provider network engagement, ... performance reporting, and present to health plans clients + Maintain detailed records of practice interactions, progress on transformation, initiatives, and market trends + Represent the organization at regional forums/clinical symposiums, conferences, and… more
- Fujifilm (Sacramento, CA)
- …for proper billing, coding, and collection under current commercial and federal payer rules for local environment. + Develops project summary documents such as ... workflow diagrams, site profile summaries, and Compiles data on specific functions, as required. + Manages client expectations to ensure customer satisfaction. This position can include both implementation as well as post go live follow up. + Identifies… more
- Sharp HealthCare (Santee, CA)
- …procedures for confidentiality and HIPAA guidelines.Documentation meets all third-party payer (Medicare, PPO, Work Comp and HMO) and regulatory ... requirements.Completes all notes and billing daily.Completes all tasks and documentation needs (ie utilization management, plan of care, medical necessity reviews) based on department and regulatory requirements.*Professional and Departmental… more
- Dignity Health (Bakersfield, CA)
- …- Minimum of eight (8) years of progressive experience in provider contracting, payer negotiations, managed care strategy - At least five (5) years in a ... leadership role managing contracting or network development teams - Bachelors degree in Healthcare Administration, Business, or a related field. - Deep knowledge of capitation models, value-based agreements, and IPA structures - Proven negotiation skills and… more