- Molina Healthcare (Cleveland, OH)
- …from government and accreditation regulators. + Directs the team in providing physician leadership and expertise in the performance of prior authorization, inpatient ... experience + Peer review, medical policy/procedure development, and provider contracting experience + Current clinical knowledge + Experience demonstrating strong… more
- Humana (Columbus, OH)
- …projects in quality oversight, data reporting, performance improvement, physician engagement, informatics, network development, and contract/payer relations. This ... Develops a health equity strategy to update existing value-based contracting principles + Designs a social determinant of health...EMR + Assesses behavioral health integration readiness of ACO physician practices + Leads the design of a new… more
- Travelers Insurance Company (Columbus, OH)
- …Will You Do?** + Provide overall program leadership as the organization's lead physician . Serve as the key enabler and facilitator for the Travelers medical ... input and support medical vendor strategies including vendor selection, negotiation and contracting . + Medical Direction and Oversight: + Participate in the design… more
- Holzer Health System (Gallipolis, OH)
- …visits, to assigned hospice patients and families as indicated by protocols and physician orders. * Utilizes the nursing process to deliver nursing care to hospice ... all policies and procedures of Holzer Health System and contracting service facilities, as applicable. * Performs care as...facilities, as applicable. * Performs care as ordered by physician 's plan of treatment. * Maintains necessary records and… more
- Cardinal Health (Columbus, OH)
- …evidence, technology, and tech-enabled products and services offered to specialty physician practices and industry manufacturers and partners. The solution portfolio ... team in excess of 50 FTEs, providing data- and technology-driven solutions to physician practices and industry partners. In addition, this leader will be tasked with… more
- Molina Healthcare (OH)
- …request/provider inquiries, such as eligibility and benefits verification, provider contracting status, diagnosis and treatment requests, coordination of benefits ... phone, fax, and mail according to Molina operational timeframes. + Contacts physician offices according to Department guidelines to request missing information from… more
- Molina Healthcare (Cincinnati, OH)
- …Improvement activities. + Stabilizes, improves and educates the Primary Care Physician and Specialty networks. Monitors practitioner practice patterns and recommends ... **PREFERRED EXPERIENCE:** + Peer Review, medical policy/procedure development, provider contracting experience. + Experience with NCQA, HEDIS, Medicaid, Medicare and… more
- Premier Health (Dayton, OH)
- 110 N MAIN STREET DAYTON, OH 45402 DEPT: MANAGED CARE CONTRACTING Full-Time / DAY SHIFT **REMOTE: This position will work-from-home. However, successful candidate ... data related to managed care contracts for Premier Health hospitals and physician organizations. The Liaison interprets and researches managed care contract language… more