- Humana (Boise, ID)
- …Pricer Business and System Support team responsible for administering complex Medicaid provider reimbursement methodologies. The associate will support existing ... be primarily responsible for implementation, maintenance and support of Medicaid provider reimbursement for hospitals and facilities....closely with IT, the pricing software vendor, CIS BSS, Medicaid operations , claims operations , and… more
- CVS Health (Trenton, NJ)
- …with others at all levels Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and ... to ensure State requirements. Evaluates, helps formulate, and implements the provider network strategic plans to achieve value-based contracting targets… more
- Humana (Richmond, VA)
- …premiums. Deliver project-based and ad-hoc reporting for Medicaid markets; provide insights into membership analysis, provider performance, RFPs, and market ... the Finance team and partners directly with Market CFOs, clinical teams, and provider engagement teams, focusing on Medicaid claims and premium analytics across… more
- Commonwealth Care Alliance (Boston, MA)
- …of health (SDOH) measures. The Program Manager will work collaboratively with our provider network and Quality teams to identify quality metrics that align ... performance improvement. Analyze CAHPS results to identify trends and collaborate with Provider Network , Clinical and Quality teams to address performance gaps.… more
- Commonwealth Care Alliance (Boston, MA)
- …of health (SDOH) measures. The Program Manager will work collaboratively with our provider network and Quality teams to identify quality metrics that align ... improvement. + Analyze CAHPS results to identify trends and collaborate with Provider Network , Clinical and Quality teams to address performance gaps.… more
- CVS Health (Columbus, OH)
- …process for identifying, evaluating, and completing contracting with Specialty and Medicaid provider partners. Developing relationships with leaders of specialty ... chronic kidney, oncology, polychronic/complex care, and emerging specialty types) or Medicaid provider organizations to design and execute on strategies for… more
- Molina Healthcare (Omaha, NE)
- …managed healthcare administration. Specific experience in provider services and/or operations in a Medicare and Medicaid managed healthcare setting, ideally ... this position must reside in the state of Nebraska Job Summary Molina Health Plan Network Provider Relations jobs are responsible for network development, … more
- CVS Health (Frankfort, KY)
- …day. About the Role We are seeking a dynamic leader to drive Medicaid provider compliance, audit excellence, and regulatory integrity across our organization. ... Summary Leads and ensures the delivery of high-quality internal and external Medicaid provider audit results, regulatory compliance activities, and proactive… more
- Molina Healthcare (Buffalo, NY)
- JOB DESCRIPTION Job Summary Molina Health Plan Provider Network Management and Operations jobs are responsible for network development, network ... Services staff are the primary point of contact between Molina Healthcare and contracted provider network . They are responsible for the provider training, … more
- Commonwealth Care Alliance (Boston, MA)
- …contracting, quality, compliance, medical management, and analytics teams to advance provider network operations , education, and performance improvement. ... internal and regulatory benchmarks. - Ensure provider network compliance with CMS, state Medicaid agency,...(DSNP) populations preferred. - 10+ years of experience in provider relations, contracting, or network operations… more
