Job Title Leads and supervises multidisciplinary team of healthcare services professionals in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and/or other special programs. Ensures members
JOB SUMMARY We are seeking a highly organized and results-driven Project Manager to lead and manage cross-functional strategic initiatives that support organizational growth and operational excellence. This role will partner closely with executive leadership to drive
Verizon recently acquired Frontier and plans to transition non-union Frontier employees into Verizon compensation and benefits programs. This position will be part of that planned transition. Who we are: As the largest pure-play fiber provider in
Pharmaceutical SalesTerritory Representative - Primary Care (Entry Level-Specialty) Are you looking for a lucrative career where you can make a big difference in the health of others. Does a patient-focused, innovation-driven company that will inspire you
Pharmaceutical SalesTerritory Representative - Primary Care (Entry Level-Specialty) Are you looking for a lucrative career where you can make a big difference in the health of others. Does a patient-focused, innovation-driven company that will inspire you
City/StateVirginia Beach, VA Work ShiftFirst (Days) Overview: Sentara Health is looking to hire an Integrated Case Manager, RN. This is a remote position; however, candidates must reside in Suffolk, Norfolk, VA Beach, Portsmouth, VA and the
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Claims Support Specialist Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for
Job Description Leads and manages team responsible for health plan provider engagement activities. Collaborates with senior leadership and the health plan network team to drive value-based care strategies, and operational direction for risk adjustment and quality
Job Title Provides executive level strategy and leadership for teams responsible for optimization of clinical operations across the enterprise. Develops and implements processes to ensure healthcare services functions including utilization management/care management/etc. and clinical vendors provide services in
Lead Analyst Molina Healthcare is hiring for a Lead Analyst that will handle Provider and Facility Reimbursements. This team has oversight for all lines of business within our facility reimbursement scope. This team mixes some technical
Job Title Leads and supervises team responsible for provision of support center customer service excellence to meet the needs of Molina members and providers. Ensures issues and needs are addressed fairly and effectively, and in alignment with
Job Title Provides support for health plan provider engagement activities. Drives value-based care strategies through risk adjustment and quality improvement activities. Ensures smaller, less advanced tier II and tier III providers have engagement plans to meet
Job Title Manages team responsible for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance. Collaborates with health plans identify and track savings
Job Title Provides senior level support for Molina enterprise quality improvement abstraction activities. Job Description Responsible for data collection and abstraction of medical records for Healthcare Effectiveness Data and Information Set (HEDIS) and HEDIS-like initiatives and
Pharmacist Position Molina Healthcare is hiring a Pharmacist in our Utilization Management/Prior Auth department. This position will be working Monday through Friday from 10:00am to 6:30pm CST with rotating weekends and holidays. Candidates can be licensed
Job Title Leads and supervises team responsible for payment integrity activities including recovery operations. Responsible for performance, quality levels and establishing procedures and techniques that achieve optimal payment integrity operational standards and production targets. Essential Job
Job Title Provides subject matter expertise and leadership for health plan provider relations activities. Supports network development, network adequacy and provider training and education. Serves as primary point of contact between the business and contracted providers
Business Analyst, Provider Network Molina Healthcare is hiring for a Business Analyst, Provider Network. Highly qualified candidates will have the following experience: Salesforce knowledge, a certification is helpful Managed Care / Healthcare experience in the Provider space.
Job Title Provides senior level support for marketing and communications operations activities across the Molina enterprise. Job Description Supports the development and maintenance of marketing and communications workflows, campaign schedules, and projects, and ensures successful media