- CommonSpirit Health (Rancho Cordova, CA)
- …Ensures complex payer information and reports are analyzed and summarized to provide timely operational and contracting recommendations for key internal leaders. ... the development, implementation and management of PSR system standards for contracting and payer relations. Accountabilities include: ensuring that managed care… more
- BD (Becton, Dickinson and Company) (Stuart, FL)
- …establishment, development and execution of the payor, managed care, and payer contracting medical policy initiatives in collaboration with BD's market access and ... to ensure optimal coverage and maximize reimbursement from Commercial, Medicaid and Medicare plans. The individual will also have direct supervision of the contract… more
- CareFirst (Baltimore, MD)
- …This position may request to extend that knowledge across other Commercial, Medicare and Medicaid plans as needed. This may also include assistance with ... will develop recommendations and prepare competitive analyses to include industry, regional , and internal benchmarks as needed. Research Federal, state and local… more
- J&J Family of Companies (Santa Clara, CA)
- …processes including medical policy, utilization review, health outcomes, risk management, provider contracting , and claims processing. + Develop relationships ... is responsible for developing and managing strategic relationships with national and regional health plans and other third-party payers. This role ensures that… more
- Providence (Santa Monica, CA)
- …Division. Contracting services are provided according to divisional and regional business need with priority placed on clinical/financial value, mitigating risk ... John's Health Center, recognized as one of the best regional hospitals in 17 types of care by US...rating for quality, safe care from the Centers of Medicare and Medicaid Services (CMS). Purchased Services and Physician… more
- Molina Healthcare (Lincoln, NE)
- …management policies and procedures to improve quality outcomes and decrease costs. * Provide regional medical necessity reviews and cross coverage * Standardizes ... Medicare . **Preferred Experience** * Peer Review, medical policy/procedure development, provider contracting experience. * Experience with NCQA, HEDIS,… more
- Dignity Health (Santa Maria, CA)
- …business plan. This position will work with the Director, Business Development; Regional Vice President, Market Development; or Vice President, Sales and branch ... branch monthly budget. 4. Identifies and qualifies health care relationships within regional territory with a focus on skilled nursing facilities, assisted living… more
- Banner Health (Phoenix, AZ)
- …including Stark, fraud and abuse, HIPAA, medical staff relationships, managed care contracting , provider networks and value-based care; specialized knowledge of ... FUNCTIONS 1. Provides leadership in development, implementation, and oversight of system-wide/ regional standards, programs, and/or systems for the delivery of legal… more
- Centene Corporation (Tallahassee, FL)
- …preferred. Preferred knowledge of modern business intelligence and visualization tools. ** Provider :** Experience in provider contracting , claims pricing, ... + Interpret and analyze data from multiple sources including healthcare provider , member/patient, and third-party data. + Support execution of large-scale projects… more
- The Cigna Group (Bloomfield, CT)
- **Medical Principal Job Description** **Position scope:** Primarily regional with national level case work for Cigna Healthcare (CHC) -- Cigna. **Summary description ... a clinical educator and consultant to utilization management, case management, network, contracting , pharmacy, and service operations (claims). This is an entry to… more