- Bon Secours Mercy Health (Cincinnati, OH)
- … care sites and clinicians are recognized for clinical and operational excellence. ** DIRECTOR MANAGED CARE CONTRACTING - LARGE ACCOUNTS** **| ... responsible for developing, managing, and leading the day-to-day activities associated with managed care contracting for both fee for service and risk… more
- Cardinal Health (Columbus, OH)
- …(ex. Blue Cross, Blue Shield, IPA, etc). Reporting to the Director of Managed Care , the Manager of Contracting is responsible for managing legal ... between payer and provider(s) to ensure optimal reimbursement including managed care contracting , enrollment, credentialing,...with strategy. **Essential Functions:** + In collaboration with the Director of Managed Care , negotiate… more
- Molina Healthcare (Cincinnati, OH)
- …QUALIFICATIONS:** + At least 8 years of experience in Healthcare Administration, Managed Care , and/or Provider Network Management and Operations with an ... subject matter expertise for the design and implementation of value-based care programs across Medicaid, Medicare, and Marketplace populations, ensuring alignment… more
- The Cigna Group (Independence, OH)
- …relationships with provider partners. + Intimate understanding and experience with hospital, managed care , and provider business models. + Team player with ... reside in the Cleveland or Independence, OH area.** The ** Director ** **,** **Provider Contracting Network Management** serves...of life. We guide our customers through the health care system, empowering them with the information and insight… more
- Molina Healthcare (Cincinnati, OH)
- …guidelines. + Experience in Utilization/Quality Program management + HMO/ Managed care experience **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:** ... includes strategies that ensure a high quality of patient care , ensuring that patients receive the most appropriate ...(QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to… more
- Highmark Health (Columbus, OH)
- …Insurance, Consulting or related area + 3 years Value-based reimbursement, through managed care contracting , provider reimbursement, consulting, population ... drive adoption and ROI realization. Critical partners include Advanced Analytics, Contracting , Market and Provider support teams, Actuary, Finance, Highmark Health… more
- Molina Healthcare (Cleveland, OH)
- …+ 10+ years relevant experience, including 5+ years of clinical practice and 3+ years HMO/ Managed Care experience **OR** 5 years experience as a Molina Medical ... inpatient concurrent review, discharge planning, case management and interdisciplinary care team activities. + Ensures that authorization decisions are...Director + Demonstrated experience in Utilization/Quality Program management +… more
- Evolent (Columbus, OH)
- …professional experience in claims-based healthcare analytics with a payer, provider, vendor, managed care , or related healthcare consulting entity + Extensive ... people with most complex and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented health care … more
- Molina Healthcare (Akron, OH)
- …in the health care field including, but not limited to, provider's office, managed care organization, or other health care environment. * 3+ years ... in negotiating different provider contract types, ie physician, group and hospital contracting , etc. * Working familiarity with various managed healthcare… more