- Apex Health Solutions (Houston, TX)
- …Collaborates effectively with Utilization Management, Quality Management, Pharmacy, Provider relations and other health plan departments Adheres to ... Conducts chronic disease and self-management education and support to improve comprehension, health literacy and adherence to established plan of care. Provides… more
- Sharp HealthCare (San Diego, CA)
- **Facility:** Health Plan **City** San Diego **Department** **Job Status** Regular **Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** Doctor of ... Senior Medical Director position provides critical management and oversight for Sharp Health Plan 's (SHP) physicians (Medical Directors (both medical and… more
- Molina Healthcare (San Diego, CA)
- …issues and implement resolution strategies. + Serves as a thought partner to health plan leadership and provide well-reasoned recommendations that support ... expertise and responsibility for oversight, production, and resolution of Health Plan Payment Integrity (PI) recovery concepts....Partners with Network to communicate recovery projects so that provider relations can be informed and respond… more
- CVS Health (San Antonio, TX)
- …including clinical and operational leadership, value-based care, quality management teams and provider relations teams to align provider performance ... - Quality Assurance: Conduct regular audits, reviews, and assessments of provider practices, documentation, and compliance. Provide feedback and recommendations… more
- CVS Health (Lansing, MI)
- …and lead collaboration internally and externally to support coordinated care. 7. Partnering with Plan leaders, Network, and provider relations teams to drive ... serve as a strategic and operational partner to the Health Plan CEO, COO, CFO and other...developing the appropriate enterprise and local strategies to fulfill plan business goals and growth imperatives. 4. Provide… more
- CVS Health (Springfield, IL)
- …care and lead collaboration internally and externally to support coordinated care. Partner with Plan leaders, Network, and provider relations teams to drive ... outcomes. **Primary Job Duties & Responsibilities:** Responsibilities specific to Behavioral Health activities across all health plan populations. Develop,… more
- Veterans Affairs, Veterans Health Administration (Casper, WY)
- …team, external relations , customer service and patient education. Ability to provide and receive guidance and technical direction. Ability to plan , organize, ... Summary The Veterans Health Administration (VHA) supports the provision of patient...receive guidance from more experienced staff members and may provide guidance to less experienced staff members but requires… more
- Prime Healthcare (Ontario, CA)
- …all aspects of the Employee Health Plans. The VP of Health Plan Operations and Claims will provide strategic leadership and development of the Claims ... Responsibilities This position requires relocating to Ontario, California. TheVice President of Health Plan Operations and Claims is responsible for the… more
- CVS Health (Hartford, CT)
- …long-term strategic planning. The Executive Director will oversee network management and provider relations , while also crafting a forward-looking vision to ... with heart, each and every day. **Position Summary** First Health is a large, national Preferred Provider ...competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan ** (including matching… more
- Banner Health (Phoenix, AZ)
- …extracts of pharmacy, eligibility, provider , or medical claims data for health plan pharmacy utilization management and audit functions. 8. Participates in ... and supports Insurance Division members and network providers and support staff, Health Plan leaders, and Insurance Division executives concerning pharmacy… more