- UPMC (Erie, PA)
- …optimal clinical and quality outcomes for members. + Works with Member Services, Network Management and Quality Management staff to assure that ... Professional Care Manager to support the Community Based Care Management team in Erie, PA! The Care Manager will...on advanced-level knowledge of the service delivery system, the provider network , member services policies, members' rights… more
- UPMC (Media, PA)
- …optimal clinical and quality outcomes for members. + Works with Member Services, Network Management and Quality Management staff to assure that ... solves based on advanced-level knowledge of the service delivery system, the provider network , member services policies, members' rights and responsibilities,… more
- UPMC (Pittsburgh, PA)
- …optimal clinical and quality outcomes for members. + Works with Member Services, Network Management and Quality Management staff to assure that ... solves based on advanced-level knowledge of the service delivery system, the provider network , member services policies, members' rights and responsibilities,… more
- Highmark Health (Pittsburgh, PA)
- …and payment strategy. The role also leads the strategy and creation of provider network designs and programs. The incumbent is responsible for understanding ... to drive provider performance in the domains of reimbursement and network programs. Specifically, the incumbent will lead the strategy and creation of… more
- St. Luke's University Health Network (Orwigsburg, PA)
- …Director, Quality and Patient Safety is responsible for all aspects of Quality , Clinical Risk Management and Patient Safety for their assigned entity. This ... changes to enhance patient safety, and collaborate with the network partners to enhance the delivery of quality...Quality (CPHQ) or Certified Professional in Healthcare Risk Management (CPHRM) or appropriate alternative within 2 years of… more
- The Cigna Group (Erie, PA)
- **WORK LOCATION: Pittsburgh, PA - Western PA/West Virginia market** The **Manager, Provider Contracting Network Management ** serves as an integral member of ... management of the day to day contracting and network management activities for a local given...and manages initiatives that improve total medical cost and quality . + Drives change with external provider … more
- CVS Health (Harrisburg, PA)
- …in your next role? Join Aetna/CVS Health, a Fortune 4 company, as the Network Management Senior Manager. In this role, you will manage negotiations, conduct ... Promote collaboration with internal partners. * Evaluate, formulate, and implement the provider network strategic plan to achieve contracting targets and manage… more
- Magellan Health Services (PA)
- …consistent and supportive provider experience. + Act as liaison between Clinical, Quality , and Network and the provider community, sharing provider ... is responsible for building, maintaining and enhancing relationships with network providers by sharing performance, quality , and... adequacy, network trends, and recruitment to Network Management and internal Magellan teams. (10%)… more
- Centene Corporation (Harrisburg, PA)
- …Manages Network performance for assigned territory through a consultative/account management approach + Evaluates provider performance and develops strategic ... of managed care or medical group experience, provider relations, quality improvement, claims, contracting utilization management , or clinical operations.… more
- Highmark Health (Harrisburg, PA)
- …with contractual terms through regular on-site audits. Apply an active role in network management , training, monitoring and enforcement of company policies and ... marketplace by staying abreast of changes to the business climate. Monitor provider reimbursement methods and PPO/DHMO/EPO network models and communicate changes… more