- The Cigna Group (Tampa, FL)
- …total medical cost and quality. + Drives change with external provider partners by assessing clinical informatics and offering consultative expertise to assist ... reviews, and projects financial impact of larger or complex provider contracts and alternate contract terms. +...partners. + Intimate understanding and experience with hospital, managed care , and provider business models. + Team… more
- The Cigna Group (Sunrise, FL)
- …improve total medical cost and quality. + Drives change with external provider partners by offering consultative expertise to assist with total medical cost ... + Prepares, analyzes, reviews, and projects financial impact of provider contracts and alternate contract terms. +...and managing relationships + Understanding and experience with managed care , and provider business models a plus… more
- Centene Corporation (New Port Richey, FL)
- …account management and accountability for issue resolution. Drive optimal performance in contract incentive performance, quality, and cost utilization. + Serve ... and align to performance-based agreements that incentivize better patient outcomes, cost -efficiency, and quality care . + Performance Management: Uses data… more
- CVS Health (Tallahassee, FL)
- …managing medical cost issues and initiating appropriate action from the provider perspective. + Key contributor to enhanced provider service solution like ... ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we reach millions… more
- MyFlorida (Tallahassee, FL)
- …program office liaison, negotiates contract terms and conditions, performing cost analyses of provider budgets. Maintains proper documentation of ... laws, rules, regulations, and guidelines. + Develops and execute provider contracts/competitive solicitations addressing standard contract documents, services… more
- Centene Corporation (Orlando, FL)
- …account management and accountability for issue resolution. Drive optimal performance in contract incentive performance, quality, and cost utilization. + Serve ... degree in related field or equivalent experience. Two years of managed care or medical group experience, provider relations, quality improvement, claims,… more
- Molina Healthcare (St. Petersburg, FL)
- …Maintains contractual relationships with significant/highly visible providers. + Advises Network Provider Contract Coordinators and Specialists on negotiation of ... Preferred, Acceptable, Discouraged, Unacceptable (PADU) guidelines. + Develops and maintains provider contracts in APTTUS contract management software. + Targets… more
- Communities Connected for Kids (Port Saint Lucie, FL)
- …with law and policy. + Maintains documentation of all activities in official contract files. + Conducts cost -benefit analyses for contracted services. Evaluates ... and outcomes are submitted timely and in compliance with contract terms. + Ensures provider compliance with...or oversight of child welfare program delivery. Experience with contract management systems and Community-Based Care initiative.… more
- Molina Healthcare (FL)
- …area.) **Job Qualifications** **REQUIRED EDUCATION** : Associate's Degree or equivalent provider contract , network development and management, or project ... customer service, provider service, or claims experience in a managed care setting. * Working familiarity with various managed healthcare provider … more
- CVS Health (Tallahassee, FL)
- …+ Provide excellent customer services for high volume inbound provider calls for the Claims Inquiry/Claims Research Medicaid team. Extensive claims research ... framework to make financial decisions to resolve provider issues. Explain provider 's rights and responsibilities in accordance with contract . + Process claim… more