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About NYC Health + Hospitals MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.
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About KindbodyKindbody is a leading fertility clinic network and family-building benefits provider for employers offering comprehensive virtual and in-person care. As the fertility benefits provider, technology platform, and direct provider of high-quality care, Kindbody delivers a seamless, integrated experience with superior health outcomes at lower cost, making fertility care more affordable and accessible for all.
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The ideal candidate will have extensive business leadership experience, with several years in a managed care environment leading a network development/provider relations function, including proven experience leading contracting for Medicare products.
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Works with Staff and Senior Management to develop and implement provider contracting strategies and provider service strategies to improve member access and enhance Provider satisfaction with the Health Plan. Primary Health Plan liaison for Claims, Member Services, Care Management, and other key departments within the Health Plan. Responsible for facilitating positive, professional relationships within the managed care organization, Providers, and the community.
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Complex providers may include, but are not limited to large institutional providers, large medical groups and ancillary providers, value based concepts understanding and support, providers in areas with strong competition or where greater provider education around managed care concepts is required.
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1 - 5 years of Health care or managed care with Provider Contracting, Network Management or Provider Relations experience. As part of Humana’s Primary Care Organization, which includes CenterWell Senior Primary Care, Conviva’s innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost.
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Hughes Network Systems, LLC, an EchoStar Company, (Hughes) is the world's leading provider of satellite broadband for home and office, delivering innovative network technologies, managed services, and solutions for enterprises and governments globally, using satellites in geosynchronous orbit as well as low earth orbit.
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As a member of the largest nonprofit provider of care in the country, we are able to share best practices and knowledge across our smart network. Borgess Ascension Hospital includes more than 130 sites of care in 15 southern Michigan cities, as well as eight owned or affiliated hospitals, a nursing home, ambulatory care facilities, home health care, physician practices, managed care services, a cancer center and an air ambulance service.
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Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County.
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Knowledge of the service provider industry, subcontracting, and licensing and regulatory systems; and knowledge of provider network contracting in a managed care model preferred.
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A strong working knowledge of military health care system including TRICARE health benefits, fee –for service principles, preferred provider network and managed care/HMO organizations is highly desirable.
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Performs other related tasks as directed by the VP Provider Network Operations & Credentialing Director. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics.
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The Provider Contracting Manager is responsible for leading or assisting with network development activities of commercial and government programs including: preparing contract proposals in accordance with financial, operational and quality objectives, drafting and negotiating contract terms, contract implementation and maintenance.
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The position is responsible for conducting regular meetings with providers, reviewing Assessments & Care Plans, providing guidance on clinical best practices, and assisting with escalation of cases that require additional assistance from L.A. Care. The position works directly with Care Management and Provider Network Management staff to inform Provider capacity-building and training activities related to the ECM Program operations.
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Professional, facility, and ancillary contracts for the PHC provider network. Knowledge of managed care, contracting, policies, and procedures. Coordinator II is responsible for, Contracting Department tracking, and reporting provider network.
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provider network managed care jobs
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