- The Cigna Group (Pittsburgh, PA)
- …this team, you'll gain firsthand insight into how healthcare products are built, launched, and managed to improve care for millions of patients. If you will be ... **Join our Care Solutions team and help shape the future...As a** **Clinical Program, Sr. Advisor** **, you will lead the development, implementation, and management of clinical programs… more
- HCA Healthcare (Loxahatchee, FL)
- …contracting issues. + Provides medical consultation on contracting, pricing, and analysis of managed care issues. Offers clinical support for appeals and denials ... regarding delegated utilization management and disease management operations under managed care contracts. Meets all regulatory/contractual/accreditation requirements… more
- Dignity Health (Bakersfield, CA)
- …care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, ... will lead the development and execution of Medicaid value-based care strategy and foster strategic relationships with key external stakeholders, including… more
- CVS Health (CT)
- …open to qualified candidates within the United States. **Required Qualifications** 10+ years of Managed Care experience in health plan and/or PBM roles 10+ years ... CMS audit experience HPMS experience **Preferred Qualifications** 15+ years of Managed Care experience in health plan and/or PBM roles 15+ years Medicare… more
- Point32Health (ME)
- …responsible management experience in a complex healthcare setting. Experience in managed care contracting and experience working collaboratively with providers. ... and lead teams to achieve goals. + Strong working knowledge of managed care /risk contracting payment methodologies. + Savvy negotiator with experience in a… more
- Humana (Lincoln, NE)
- …policy administration or related field;work experience may meet this need + 5 + years managed care experience + 5 + years in Medicaid program implementation or ... and clinical operations; Medicaid preferred + Comprehensive understanding of a Medicaid Managed Care architecture, tools, utilities and processes utilized to… more
- Molina Healthcare (Joliet, IL)
- …Transition and/or acquisition experience. Direct experience with Medicaid and Medicare managed care plans. **PHYSICAL DEMANDS:** Working environment is generally ... Healthcare's State Health Plans, providing a wide range of quality health care services to families and individuals who qualify for government-sponsored programs,… more
- Abbott (Alameda, CA)
- …**What You'll Do** + Lead the negotiation of complex contract terms for Managed Care / Market Access contracts across large PBM/GPO relationships. + Employ a ... lead healthier, happier lives. As a global leader in diabetes care , Abbott is constantly...contract development and negotiation for the Market Access / Managed Care Channel. The position will work… more
- Truecare Homecare Agency (Brooklyn, NY)
- …+ Audits + Coordinate and prepare all documentation for state DOH, Medicaid, Managed Care Organizations, or accreditation body audits. + Serve as the ... New York homecare ecosystem, including a deep understanding of LHCSA regulations, Managed Long Term Care (MLTC) relationships, Uniform Assessment System (UAS)… more
- Pfizer (Frankfort, KY)
- …as appropriate. The individual may be involved in presentations to payers, managed care organizations, formulary decision makers and regional medical advisory ... of the following: + Clinical, formulary, and/or other management experience + Managed Care , pharmaceutical industry, and/or Quality Improvement + Data Analytics… more