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
Job Description Provides senior level support for claims recovery activities including researching claim payment and billing guidelines, audit results, and federal regulations to determine overpayment accuracy and provider compliance. Collaborates with health plans and vendors to
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 Leads and manages team responsible for configuration activities including accurate and timely implementation and maintenance of critical information on claims databases, validation of data stored on databases, and adherence to health plan business and
Job Title Provides lead level support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Contributes to overarching strategy
Senior Specialist, Quality Program Management and Performance The Senior Specialist, Quality Program Management and Performance implements new and existing healthcare quality improvement activities to maintain compliance with quality program requirements and reporting and monitoring for key
Job Title Job Description Job Summary Provides senior level support for implementation of health plan provider engagement strategies and activities to drive necessary quality and risk adjustment outcomes Uses a consultative approach emphasizing physician engagement and
Commercial Lines Assistant Account Manager The Company: Exciting opportunity to join a leading insurance brokerage in Los Angeles, looking to invest in its team and welcome you to the team! In this role, you will be