- Commonwealth Care Alliance (Boston, MA)
- …health and social needs** **Knowledge, Skills & Abilities (Required)** **Understanding of health plan operations and delivery system** **Excellent group ... **Experience (Required):** **5+ years** **5-7 years of experience in the health plan service, operations or engagement.** **5+ years of experience… more
- BlueCross BlueShield of North Carolina (NC)
- …justice-involved youth across the Eastern Region of North Carolina. This role bridges health plan operations across Medicaid programs-Healthy Blue and ... business objectives, member outreach, retention activities, and cultural sensitivity initiatives for health plans. + Strategies will include but are not limited to… more
- Prime Healthcare (Ontario, CA)
- …and state financial reporting regulations. + Collaborate with cross-functional teams including Health Plan Operations , Patient Access, Marketing, IT, and ... Overview Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare...implement, and manage the Revenue Integrity & CDM Compliance Plan . + Ensure compliance with CMS Price Transparency Rule… more
- Healthfirst (NY)
- …using Agile methodologies. Exposure to Scaled Agile (SAFe) preferred. + Experience working with health plan operations and IT + Experience working as a ... by collaborating closely with peers, leaders, and staff throughout Operations to ensure the appropriate parties are contributing. +...+ Experience leading large scale change initiative in a health plan setting + Demonstrated understanding and… more
- Kelsey-Seybold Clinic (Pearland, TX)
- …and external software applications to provide Concierge type services related to health plan operations including benefit interpretation for providers, ... **Responsibilities** Managed Care Representatives respond to inquiries from health plan members, providers and various customers while consistently meeting… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …+ Deep and broad understanding of health care delivery system and health plan operations , including knowledge of Medical Economics, Trend Management, ... , Blue Cross Blue Shield of Massachusetts is a community-focused, tax-paying, not-for-profit health plan headquartered in Boston. We have been a market leader… more
- Pfizer (New York, NY)
- …business acumen + Highly developed knowledge of healthcare industry, provider network, and health plan operations + Experience establishing strategic vision, ... position is eligible for participation in Pfizer's Global Performance Plan with a bonus target of 30.0% of the...and personal days, paid caregiver/parental and medical leave, and health benefits to include medical, prescription drug, dental and… more
- State of Georgia (Fulton County, GA)
- …and posting, and plan data change management post-open enrollment. Manages day-to-day health insurance carrier operations related to plan offerings and ... Issuer Operations Manager - State Based Exchange Georgia -...with network adequacy standards in support of annual Quality Health Plan (QHP) review and certification. Oversees… more
- Centene Corporation (Charlotte, NC)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** **:** Supports health plan operations through medical management, quality ... 28 million members as a clinical professional on our Medical Management/ Health Services team. Centene is a diversified, national organization offering competitive… more
- McLaren Health Care (Flint, MI)
- …in providing superior claims operations for McLaren Integrated HMO Group's health plan subsidiaries (HP). Specific areas of responsibility include, but not ... Care Corporation and is the parent company of McLaren Health Plan in Michigan and MDwise, Inc....+ Four (4) years' experience in health plan claims, billing or claims adjudication operations … more
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