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Health Net
- Little Rock, AR
Responsible for analytic data needs of the business unit. Handle complex data projects and acts as a lead for other Data Analysts. Provide advanced analytical support for business operations in all or some of the following areas claims, provider data, member data, clinical data, HEDIS, pharmacy, external reporting Extract, load, model, and reconcile large amounts of data across multiple system pla
Posted 4 days ago
Perform various analysis and interpretation to link business needs and objectives for assigned function Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of new systems Identify and analyze user requirements, procedures, and problems to improve existing processes Perform detailed analysis on assigned projects, recommend potent
Posted 4 days ago
Director, Medical Management (Complex Care Products) (1080154) Position Purpose Provide strategic leadership and guidance in medical management and quality across all Centene's Medicare Advantage Plans. Ensure compliance with all Centers of Medicare/Medicaid Services (CMS) clinical, quality, and service requirements and ensure a centralized structure to support the Medicare business unit. Act as a
Posted 9 days ago
Maintain accurate databases and reports to monitor network compliance with State requirements Create and maintain multiple databases, including, contract provider network, prior authorization, third party liability, provider set ups and related corrections Oversee the provider termination process including adding and changing new or existing provider records in the medical information system Sched
Posted 10 days ago
Billing Operations Specialist (1080226) Position Purpose Collaborate with internal team and external client to research and resolve any disputes or discrepancies in billed amounts and/or payment transactions Prepare timely and accurate billing for external clients Document all collections efforts and transaction records Reconcile member accounts as needed Prepare bad debt write off as needed Resea
Posted 10 days ago
Program Specialist I (Social Work) (1080914) Position Purpose Identify special needs members through the completion of health screens and other resources Work with community outreach/member advocates to coordinate member care Educate providers and community resources on program components and available support services Educate members with special needs to foster compliance with program and positi
Posted 13 days ago
Contracts Coordinator (Little Rock) (1080138) Position Purpose Assist with the contract submission process and the auditing of provider information systems (AMISYS) for consistency and best practices in Provider set up. Maintain spreadsheets and collect, track, prepare, compile, and distribute statistical data for daily and monthly reports. Maintain and report on the Health Plan(s) compliance with
Posted 13 days ago
Contract Analyst II (Little Rock) (1080150) Position Purpose Provide analytic support for network performance, unit cost trend, network profiling and evaluation, and contract modeling for current health plans, future business, and new products. Utilize applications and tools to support network performance management reporting and analytic needs. Evaluate and monitor financial performance of key pr
Posted 13 days ago
Business Analyst II (1079330) Position Purpose Perform various analysis and interpretation to link business needs and objectives for assigned function Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of new systems Identify and analyze user requirements, procedures, and problems to improve existing processes Perform detailed
Posted 13 days ago
Perform duties related to the day to day operations of the High Risk Case Management functions to include working with members identified as high risk to identify needs and goals to achieve empowerment and improved quality of life. Assess members' current functional level and, in collaboration with the member, develop and monitor the Case Management Treatment Plan, monitor quality of care; assisti
Posted 13 days ago
Concurrent Review Nurse I RN Preferred (1081221) Position Purpose Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations Complete medical necessity and level of care reviews for req
Posted 17 days ago
Care Manager I (RN) (1081153) Position Purpose Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care Develop, assess and adjust, as necessary, the care plan and promote desired outcome Assess the member's current health status, resource utilization, past an
Posted 17 days ago
Lead and direct process improvement activities that provide more efficient and streamlined workflow. Responsible for leading and collaborating with others on National Committee for Quality Assurance (NCQA) Accreditation and/or Healthcare Effectiveness Data and Information Set (HEDIS) performance Responsible for quality improvement aspects of risk adjustment processes for all products Collaborate w
Posted 18 days ago
Contract Negotiator (Little Rock) (1080137) Position Purpose Coordinate and negotiate hospital, physician (IPAs, PPMs, individual providers, multi specialty groups) and ancillary service agreements that are in accordance with corporate, health plan and State guidelines. Recruit and develop provider network plan for region and set of providers Identify and initiate contact with potential providers
Posted 18 days ago
Accreditation Specialist (1079909) Position Purpose Develop Performance Improvement projects to improve clinical quality and performance measure outcomes. Develop and coordinate delegation oversight mechanisms and act as liaison for the Plan with Corporate Delegation Oversight. Develop and maintain accreditation readiness schedule. Creates policy and procedures to support accreditation activities.
Posted 18 days ago
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