- Elevance Health (Costa Mesa, CA)
- **JR177558 Behavioral Health Care Manager I** The Behavioral Health Care Manager I is responsible for conducting utilization management reviews for mental health ... assessment and short-term problem resolution and referral to appropriate provider (s). **Location:** Virtual: This role enables associates to work virtually… more
- Fresenius Medical Center (Dallas, TX)
- …planning, evaluation, coordination, and implementation of various managed health care programs (HMOs, PPOs, POS, etc). Oversees Division's contractual relationships ... with managed care organizations and other third party payors regarding rate...establishment of other business terms per the FMCNA Guidelines, contract maintenance such as facility list updates and amendments.… more
- Martin's Point Health Care (Portland, ME)
- Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a ... people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …providers, and interdisciplinary teams to assess behavioral health needs, develop individualized care plans, and ensure cost -effective, quality care in ... are cost -effective and meet quality standards, consistent with managed care requirements and clinical best practices. + Maintain accurate and timely… more
- Trinity Health (Livonia, MI)
- …decisions, and outcomes. Directs alignment and standardization for Pharmacy Long Term Care Operations to provide high-quality, cost -effective patient ... 25% to 45% travel.** **POSITION PURPOSE** The Pharmacy Director Long Term Care Operations is a licensed registered pharmacist accountable for leading, managing and… more
- Love's Travel Stops & Country Stores (Oklahoma City, OK)
- …and develop and execute category sourcing strategies focused on minimizing total cost of ownership and maximizing service quality. **Job Functions** : + **Enables ... Agreements + Leads and conducts the RFP process, bid analysis and review, contract negotiations, and blanket purchase agreement creation + **Identify and realize … more
- UPMC (Pittsburgh, PA)
- …retrospective reviews, member grievances, provider appeals, and potential quality of care concerns. + Provide expedited review and determination of medically ... and execute on our population health strategy, clinical and provider operations, and State contract and CMS...implementation of medical management initiatives to improve quality and cost effectiveness of care delivered. + Key… more
- Humana (Tallahassee, FL)
- … efficiency, and population health outcomes through strategic provider partnerships, data-informed decision-making, and cross-functional collaboration. The RVP ... and maintain trusted relationships with CMOs and senior executive/clinical leaders at provider and care delivery partner organizations. First and foremost, this… more
- Veterans Affairs, Veterans Health Administration (Georgetown, DE)
- …of the Veteran. The incumbent references quality improvement information and organizes patient care needs to assure safe, efficient, and cost -effective care ... The incumbent works as a member of a primary care team consisting of clerical staff, nurses, physicians, social...well as occasional travel to other VA clinics to provide clinical coverage. The candidate must be willing to:… more
- Rush University Medical Center (Chicago, IL)
- …and anticipated) with available resources and proactively resolve barriers. Promotes cost -effective quality care services. * Participates in development, ... which is specific to the patient/family learning abilities and language preference. * Identifies care management contract outcomes by using care management … more