- Molina Healthcare (Madison, WI)
- …and ensure adherence to business, system and regulatory requirements of Provider Data Management / Network Adequacy. **Knowledge/Skills/Abilities** + ... among multiple systems to ensure accurate reporting of the Provider Network across the enterprise. Validate data...Integrates work with other teams including New Markets team, Network Management , Product Teams, PDM and IT.… more
- Evolent (Madison, WI)
- …Account teams and payer clients to align priorities and deliver high-quality provider network engagement, performance reporting, and present to health plans ... OR THE WEST REGION We are seeking a strategic and collaborative Associate Director , Provider Engagement to lead our oncology-focused provider engagement… more
- CVS Health (Madison, WI)
- …do it all with heart, each and every day. **A Brief Overview** The Lead Director , Provider Data Compliance is responsible for overseeing the compliance of ... readiness and collaborates with Compliance, Legal, Medicaid Health Plans, Network Contracting, and Provider Relations to ensure...+ A minimum of 2 years of experience in provider data management and contracting support. +… more
- Datavant (Madison, WI)
- …to customer outcomes, regulatory drivers, and market trends in risk adjustment, care management , and provider enablement. + Identify and prioritize use cases ... is powered by the largest, most diverse health data network in the US, enabling data to be secure,...across different facets within prospective and concurrent solutions. + Provide mentorship, performance management , and career development… more
- Centene Corporation (Madison, WI)
- …consultants for reviewing complex cases and medical necessity appeals. + Participates in provider network development and new market expansion as appropriate. + ... standards. + Actively practices medicine **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the medical management , quality… more
- Sumitomo Pharma (Madison, WI)
- …the design and execution of program operations, systems, metrics, and HUB vendor network . The Director will work closely with key stakeholders including the ... seeking a dynamic, highly motivated, and experienced individual for the position of ** Director , Patient & HUB Operations, Rare Disease** . The Director , Patient… more
- Datavant (Madison, WI)
- …the right format. Our platform is powered by the largest, most diverse health data network in the US, enabling data to be secure, accessible and usable to inform ... experiences to realize our bold vision for healthcare. The Director of Client Success will report to the VP...resources across the company + Interpret client needs and provide expertise for internal product development and advanced development… more
- Merck (Madison, WI)
- …deal sourcing, vetting, diligence, financial modeling, investing, as well as investment management and governance. The Director will work closely with our ... of our Company's Global Health Innovation Fund team, the Director is an entrepreneurial individual who will be expected...expected to lead investment activities across the GHI Fund management team with a primary focus of supporting Commercial… more
- Highmark Health (Madison, WI)
- …cross organizational programs and projects + 5 years Familiarity with health plan and provider contracting or revenue management + 2 years Understanding of ... provider contract documents and overall contract management process **LICENSES or CERTIFICATIONS** **Required** + None **Preferred** + None **SKILLS** + Excellent… more
- Molina Healthcare (Madison, WI)
- …as meeting or exceeding productivity standards. Educates and interacts with network and group providers and medical managers regarding utilization practices, ... guideline usage, pharmacy utilization and effective resource management . + Develops and implements a Utilization ...(QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to… more
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