- BrightSpring Health Services (Louisville, KY)
- …and behavioral health, we provide comprehensive and more integrated care and clinical solutions in all 50 states to over 450,000 customers, clients and ... patients daily. BrightSpring has consistently demonstrated strong and often industry-leading quality metrics across its services lines while improving the quality of life and health for high-need individuals and reducing overall costs to the healthcare system.… more
- Insight Global (Hayward, CA)
- …flow. * Collaboration & Requirements Gathering: Work closely with operational, clinical , and business stakeholders to understand requirements, define key metrics, ... and translate business needs into effective BI solutions. * Performance Optimization: Optimize Qlik dashboards, data pipelines, and data models for performance, scalability, and usability. * Support & Documentation: Provide end-user support and maintain clear,… more
- Henry Ford Health System (Detroit, MI)
- …validates the diagnostic and/or procedural codes applied from front-end coding and clinical teams for reimbursement and billing purposes. The CBO Coding Complex ... Specialist accurately abstracts information from the electronic health record for compilation of a patient database, which supports medical research projects, patient care evaluation and administrative decision making related to patient care. The coding… more
- Molina Healthcare (Longview, TX)
- …Molina risk adjustment and quality efforts (eg Supplemental data, EMR connection, Clinical Profiles programs) and use of the Molina Provider Collaboration Portal. * ... Tracks all engagement and training activities using standard Molina Provider Engagement tools to measure effectiveness both within and across Molina Health Plans. * Serves as a Provider Engagement subject matter expert; works collaboratively within the Health… more
- The Cigna Group (Bloomfield, CT)
- …recommendations based on performance results. + Collaborate cross-functionally with clinical , product, network, and finance partners to influence decision-making and ... drive performance improvement. + Support and maintain savings scorecards, ensuring emerging risks and opportunities are identified, quantified, and communicated effectively. + Translate ambiguity into structured plans, actionable insights, and measurable… more
- Charles River Laboratories (Wilmington, MA)
- …provides a suite of products and services to support our clients' clinical laboratory testing needs and manufacturing activities. Utilizing this broad portfolio of ... products and services enables our clients to create a more flexible drug development model, which reduces their costs, enhances their productivity and effectiveness to increase speed to market. With over 20,000 employees within 110 facilities in over 20… more
- Insight Global (Nottingham, MD)
- …focuses on resolving underpayments, denials, and contract interpretation issues-not clinical denials or patient balances. The representative ensures accurate ... reimbursement by analyzing Explanation of Benefits (EOBs), identifying discrepancies, and initiating corrective actions with payers. This team focuses on facility claims only, and this role is focused only on outpatient claims follow up, specifically to BCBS.… more
- Oracle (Frankfort, KY)
- …work on the Front End of the next generation Oracle Health Clinical Applications. Join the team modernizing healthcare with cloud-native, AI-powered applications ... that you'll design end to end-from elegant, accessible UIs to resilient microservices at massive scale. You'll partner with product, UX, and platform teams to ship secure, high-availability features that clinicians and patients rely on every day. Expect to… more
- UPMC (Pittsburgh, PA)
- …and gain support for data-based recommendations with team members from product, clinical , network, and strategy functions. + Bring clarity to complex problems using ... exceptional communication skills when engaging with senior leadership and technical audiences. + Apply an understanding of complex actuarial concepts, methods, and applications in a variety of situations and deliver results to leadership. + Creatively leverage… more
- Molina Healthcare (WA)
- …Visio (flow chart equivalent) **PREFERRED QUALIFICATIONS:** + Degree in Preferred field: Clinical Quality, Public Health, or Healthcare + 5 years of experience in ... health plan quality management + Experience with data reporting, analysis, and/or interpretation + Active, unrestricted Certified Professional in Health Quality (CPHQ) + Active, unrestricted Nursing License (RN may be preferred for specific roles) + Active,… more