- CVS Health (Coral Gables, FL)
- …- Miami Dade or Broward County** **Preferred Qualifications** + Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claim Lifecycle, ... by assisting with or responding to complex issues regarding Medicaid policies and procedures, plan design, contract language, service,...Provider Appeals & Disputes, and Network Performance Standards. + Experience in Medical Terminology, CPT,… more
- Molina Healthcare (GA)
- …in Georgia _** **JOB DESCRIPTION** **Job Summary** Molina Health Plan Provider Network Management and Operations jobs are responsible for network development, ... and in compliance with all relevant federal, state and local regulations. Provider Network staff are the primary point of contact between Molina Healthcare and… more
- Elevance Health (Ashburn, VA)
- ** Network Relations Consultant** **Location:** _Hybrid1:_ This role requires associates be in the office 1-2 days per week, fostering collaboration and ... employment, unless an accommodation is granted as required by law. The ** Network Relations Consultant** develops and maintains positive provider relationships… more
- Abbott (Livermore, CA)
- …health and get on with their lives. This position leads payor relations (including payor contracting) and regulatory affairs, which are foundational functions to ... payor contract negotiation, payor contract implementation, payor contract monitoring, Medicare/ Medicaid enrollment, state licensing, and Joint Commission accreditation +… more
- Dignity Health (Bakersfield, CA)
- **Job Summary and Responsibilities** The Provider Relations Representative is responsible for establishing and maintaining positive relationships with various ... such as eligibility, prior authorization, claims administration and provider network administration. Familiarity with managed care and self-insurance products and… more
- AmeriHealth Caritas (Detroit, MI)
- **Role Overview:** The Manager of Provider Network Management oversees the day-to-day operations of the Network Management department, including staff ... to enhance claims submission and auto-adjudication processes. **Provider Recruitment, Retention, & Relations ** + Ensure network adequacy in accordance with state… more
- Elevance Health (Las Vegas, NV)
- **Be Part of an Extraordinary Team** **Senior Provider Network Manager ** **Location:** NV-LAS VEGAS, 9133 W RUSSELL RD **Hybrid** : **This role requires ... unless an accommodation is granted as required by law._ The **Senior P** **rovider Network Manager ** is responsible for developing the provider network … more
- Elevance Health (Seattle, WA)
- …dynamic and adaptable workplace. **Position Overview:** Develops the provider network through contract negotiations (language and rates), relationship development, ... BA/BS degree and a minimum of 3 years' experience in contracting, provider relations , provider servicing; or any combination of education and experience, which would… more
- Elevance Health (Overland Park, KS)
- …distance from an office. **Position Overview:** Develops the provider network through contract negotiations, relationship development, and servicing for large ... Serves in a leadership capacity, leading associate resources, special projects/initiatives, or network planning + Serves as a subject matter expert for local… more
- Bassett Healthcare (Cooperstown, NY)
- …340B Drug Pricing Program for all qualified entities throughout the Bassett Health Network . The 340B Manager serves as the primary institutional compliance ... the best quality of life possible. What you'll do Reporting to the Chief Pharmacy Officer, the 340B Manager is responsible for compliance and administration of the… more