- AmeriHealth Caritas (Southfield, MI)
- …financial performance by identifying cost -saving opportunities, ensuring competitive provider contracts, and enhancing value-based care . + Drives member ... Degree preferred. + 10 or more years of experience years of managed care provider contracting and reimbursement experience, including in-depth knowledge of… more
- CenterWell (Phoenix, AZ)
- …for quality management/ cost and utilization / develop interventions / evaluate provider workflows / + Attend team meetings / external Meetings / shared service ... Issues / Action Items in MSO Connect (membership, payment, contract load) + Email Inbox Management + Follow-up (existing...Bachelor's Degree + 5 or more years of Health care or managed care with Provider… more
- UNC Health Care (Morrisville, NC)
- … cost models for departments, service lines, procedures, and payers. + Provide actionable insights to support pricing strategies, contract negotiations, and ... the unique communities we serve.** **Summary:** This position leads the system-wide cost accounting and decision support function for an integrated healthcare system… more
- Point32Health (Canton, MA)
- …Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and ... to understand performance, financial or otherwise, of the allied provider network. Work closely with the contract ...Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide … more
- Molina Healthcare (Jackson, MI)
- …and experience. **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** : * 4-6 years provider contract network relations and management experience in a managed ... matrix team environmental support including, but not limited to: New Markets Provider / Contract Support Services, PCRP & CSST resolution support, and National… more
- CVS Health (Columbus, OH)
- … arrangements are functioning successfully and working to improve quality of care while reducing costs. . Provider Relationship Management - Understands ... performance. (External meetings include JOCs, clinical meetings, Informatics discussions, contract reconciliations, etc.) . Drives provider performance and… more
- Molina Healthcare (OH)
- …as appropriate. **JOB QUALIFICATIONS** **Required Education** Bachelor's Degree or equivalent provider contract , network development and management, or project ... provider service, or claims experience in a managed care setting. + Working familiarity with various managed healthcare... Provider Services. + 5 years' experience in provider contract negotiations in a managed healthcare… more
- Centene Corporation (New York, NY)
- … Engagement Operating Model (PEOM), an enterprise strategic priority focused on driving provider cost and quality performance and engagement. + Manage the staff ... policies and procedures, managing provider relationships to maintain/improve provider satisfaction, provide assistance in escalating claim issues,… more
- Molina Healthcare (Bellevue, NE)
- …Maintains contractual relationships with significant/highly visible providers. + Advises Network Provider Contract Coordinators and Specialists on negotiation of ... Preferred, Acceptable, Discouraged, Unacceptable (PADU) guidelines. + Develops and maintains provider contracts in APTTUS contract management software. + Targets… more
- Molina Healthcare (Bothell, WA)
- …in HEDIS and quality initiatives. * Engages contracted network providers regarding cost control initiatives, Medical Care Ratio (MCR), non-emergent utilization, ... * 5-7 years managed healthcare administration experience. * Specific experience in provider services, operations, and/or contract negotiations in a Medicare and… more