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Associate’s degree from an accredited college or a minimum of four years’ experience with managed care contracting or payor relations. Strong analytical skills needed to compile and analyze data including: managed care denials/underpayment/ overpayment identification and resolution, contract modeling and evaluation, filing appeals as well as aiding in decision support reporting.
Full-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Key stakeholder departments include, configuration, provider relations, provider credentialing, provider enrollment, claims, medical management and payment integrity. Bachelor's degree in Business, Finance or related field, plus 5-7 years of experience in the health care industry (at least 3 years in managed care contracting), or an equivalent combination of education and experience.
ExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Skills/Attributes Required: 4+ years of healthcare/managed care experience, with a focus on provider relations and/or provider network management. Stay up-to-date with industry trends, regulations, and best practices related to provider relations and managed care.
RemoteExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Minimum 3-5 years clinical experience in any of these areas: acute care, home health, physician office management, managed care organization, provider relations, pharmaceutical sales.
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The Care Manager supports the implementation of the CareFirst Value Based Care Management program by working with CareFirst members. Abide by Value Based Care Management Program Description and Guidelines.
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Collaborates with Provider Relations to improve provider performance in areas of Quality Risk Adjustment Operations claims and encounters. Work experience should be in direct patient care social work quality improvement or health coaching preferably in a managed care environment.
$25 - $32 an hourExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Work closely with health plan leadership, the Chief Medical Officer, other Medical Leadership, Pharmacy Director, clinical staff (including those in utilization management, care management, quality management), and colleagues within network and provider relations, to enhance the delivery of holistic and integrated care.
Full-timeExpandApply NowActive JobUpdated 9 days ago - UpvoteDownvoteShare Job
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Perform medication reconciliation at the onset of care plan, after changes in health status, and every thirty days during the life cycle of the care plan, assessing for efficacy and drug interactions/side effects.
Full-timeRemoteExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Work with the Director, Provider Relations staff, and other internal PHC departments to monitor access issues and identify various types of healthcare providers and facilities for contracting opportunities.
$72,067.77 - $93,687.81 a yearExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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Minimum of 3 years relevant work experience in Network Management, Contracting or Provider Relations in a managed care setting, health plan or large medical group administration.
ExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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Candidate Education: Required A Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or related field or equivalent work experience within a managed care environment related to HEDIS record review, quality improvement, medical coding or transferable skill sets that demonstrates the ability to perform the role.
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Provides expert help to provider relations to resolve issues related to claim payment, chronic care management, and general utilization management. Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance.
Full-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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Minimum of three years experience in managed healthcare environment(s) with related work in provider contracting, healthcare finance, provider reporting/profiling, and/or provider relations.
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The BJC Managed Care department includes multiple functions such as managed care contracting, financial analysis, systems and operations, value-based care and payment programs, payor and provider relations, and direct to employer solutions.
$63,024 - $102,627.2 a yearFull-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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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.
ExpandApply NowActive JobUpdated 10 days ago
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