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5 years of relevant work experience in Network Management, Contracting or Provider Relations in a managed care setting, health plan or large medical group administration. Job Summary: The Manager of Network Operations is responsible for the general management of the Provider network as assigned by the Director of Network Operations.
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Works with the legal department, regulatory compliance teams, and Network Management contracting staff to file documents, as applicable, with the Insurance Commissioner/Department of Insurance for each state where the Health Plan contracts with providers.
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After over 50 years in business, SEI remains a leading global provider of investment processing, investment management, and investment operations solutions. This position is responsible for providing account and operational management to clients within the Advisor Network through extensive daily support and interaction.
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Ensure timely responses to regulatory agencies (i.e., NYSDOH, DFS) in response to all Provider Network regulatory and compliance issues. Department: Provider Network Operations.
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Provider network development: Individual will be responsible for promoting and selling services under current and future scope of pharmacy practice. Understanding of medical plan credentialing and provider enrollment.
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Three (3) years of experience in a Medicaid Managed Care role with direct product and/or direct program experience in contract compliance, government relations, and/or provider network is required.
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An Account Manager will gain exposure to various types of energy efficiency projects and typically provides account management, trade ally/service provider management, and other technical services for a utility energy efficiency program and their stakeholders.
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This application is used to address the Early Intervention Programs (EIPs) functions of child referral and intake, case management, developmental evaluations, service planning, service delivery, service providers claiming, service providers payment, rd party insurance claiming (commercial and Medicaid), state vouchering, provider application and approval, reporting, auditing, and compliance with Federal and State requirements.
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May conduct contract reviews for appropriate security language prior to a project/WBA signing May conduct remediation management or governance and/or escalations on vendors or operations issues requiring a solution May perform as “Level 3” support in the event Managed Service provider is unable to resolve an issue.
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Is a leading provider of mission critical solutions to government and civilian agencies with a focus on C4ISR solutions using any type of network, whether mobile, fixed, static, terrestrial, marine, airborne or in space.
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The Practice Manager is responsible for fostering a team-based and positive culture and morale transformation, leading through change management. The Practice Manager will be responsible for implementation of best practices, standardization across all sites, and for compliance with all federal and state regulations and codes.
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A provider finder/cost estimation tool, allowing members to find in-network providers and get a cost estimation before the visitA wellness program, where earning points for things like achieve step goals, can be redeemed to purchase wellness related itemsA pregnancy planning tool, that helps track fertility, baby growth, milestones, etc.
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Interact with internal departments such as Finance, Medicare Operations, Network Management, Provider Contracting, Health Services, Marketing & Sales, IT, AUA, and Compliance.
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Nuvance Health has a network of convenient hospital and outpatient locations - Danbury Hospital, New Milford Hospital, Norwalk Hospital and Sharon Hospital in Connecticut, and Northern Dutchess Hospital, Putnam Hospital Center, and Vassar Brothers Medical Center in New York - plus multiple primary and specialty care physician practices locations, including The Heart Center, a leading provider of cardiology care, and two urgent care offices.
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The Manager, Provider Network Contracting serves as an integral member of the Provider Contracting Team and reports to the Provider Contracting Senior Manager. This role assists in developing the strategic direction and management of the day to day contracting and network management activities for a local given territory.
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