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Results based on filters ( 33 jobs found )

Representative, Provider Relations HP (Idaho HealthPlan)

Affinity Health Plan
Idaho
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Representative, Provider Relations HP (Idaho HealthPlan) ID, United States ...
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About the job:
and 5 more Be the First to Apply Job Description Job Description Job Summary Molina Health Plan Network Provider Relations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Provider Relations staff are the primary point of contact between Molina Healthcare and contracted provider network. They are responsible...
Location:
Idaho
Job Type:
Full-Time
Permanent
Occupation:
Customer Service Representatives
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
Affinity Health Plan
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Health Plan Provider Contracts Manager - Complex (FL Healthplan)

Affinity Health Plan
Florida
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JOB DESCRIPTION ****Employee for this role must reside in the state of ...
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About the job:
Florida**** Job Summary Provides subject matter expertise and leadership for health plan provider network complex contracting activities. Supports network strategy and development with respect to adequacy, financial performance and operational performance. Responsible for negotiating agreements, including value-based payment methodology, with complex provider groups that are strategically critical to plan success, including but not limited to: hospitals, independent physician associations (IPAs), and behavioral health...
Location:
Florida
Job Type:
Full-Time
Permanent
Occupation:
Business Operations Specialists, All Other
Career Level / Education:
Bachelor's degree
Salary:
High Income Jobs ($80K-$99K)
From:
Affinity Health Plan
Certifications / Licenses:
Associated Professional Member
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Field Care Manager, LTSS (RN)

Affinity Health Plan
Chicago, IL
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JOB DESCRIPTION Job Summary Provides support for care management/care ...
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Summary
About the job:
coordination long-term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Completes comprehensive member assessments within regulated timelines, including in-person home visits as required. • Facilitates...
Location:
Chicago, IL
Job Type:
Full-Time
Permanent
Occupation:
Registered Nurses
Career Level / Education:
Bachelor's degree
Salary:
High Income Jobs ($80K-$99K)
From:
Affinity Health Plan
Certifications / Licenses:
Certified Case Manager
Driver's License
Certified Registered Nurse
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Associate Specialist, Appeals & Grievances

Affinity Health Plan
Arizona
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JOB DESCRIPTION Job Summary Provides entry level support for claims ...
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Summary
About the job:
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 Medicare and Medicaid Services (CMS). Essential Job Duties • Enters denials and requests for appeals into information system and prepares documentation for further review. • Researches claims issues utilizing systems and other available resources. • Assures timeliness and appropriateness of appeals...
Location:
Arizona
Job Type:
Full-Time
Permanent
Occupation:
Customer Service Representatives
Career Level / Education:
High school diploma or equivalent
Salary:
Middle Income Jobs ($30K-$49K)
From:
Affinity Health Plan
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Lead Analyst, Healthcare (Remote)

Affinity Health Plan
Arizona
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JOB DESCRIPTION Job Summary Performs research and analysis of complex ...
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Summary
About the job:
healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings. KNOWLEDGE/SKILLS/ABILITIES - Provides healthcare analysis including quantification and analysis of health care costs, development and maintenance of databases and other sources of information for quality initiatives, accreditation efforts, and regulatory mandates, and claims...
Location:
Arizona
Job Type:
Full-Time
Permanent
Occupation:
Management Analysts
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
Affinity Health Plan
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Associate Specialist, Appeals & Grievances

Affinity Health Plan
Arizona
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JOB DESCRIPTION Job Summary Provides entry level support for claims ...
Details
Summary
About the job:
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 Medicare and Medicaid Services (CMS). Essential Job Duties • Enters denials and requests for appeals into information system and prepares documentation for further review. • Researches claims issues utilizing systems and other available resources. • Assures timeliness and appropriateness of appeals...
Location:
Arizona
Job Type:
Full-Time
Permanent
Occupation:
Customer Service Representatives
Career Level / Education:
High school diploma or equivalent
Salary:
Middle Income Jobs ($30K-$49K)
From:
Affinity Health Plan
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Perinatal Medical Director (Based in MS)

Affinity Health Plan
Jackson, MS
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JOB DESCRIPTION Job Summary Provides medical oversight and expertise in ...
Details
Summary
About the job:
appropriateness and medical necessity of services provided to members, targeting improvements in efficiency and satisfaction for both members and providers and ensuring members receive the most appropriate care in the most effective setting. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Determines appropriateness and medical necessity of health care services provided to plan members. • Supports plan utilization management program and accompanying action...
Location:
Jackson, MS
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
Bachelor's degree
Salary:
High Income Jobs ($80K-$99K)
From:
Affinity Health Plan
Certifications / Licenses:
National Committee for Quality Assurance
Board Certified
Certified Professional in Healthcare Quality
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Representative, Care Connections Member Advocate - Must Be Bilingual in Cantonese, and Tagalog, M - F 8:30AM - 5:30PM Pacific Time Hours - CA ONLY

Affinity Health Plan
California
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Job Description Job Summary Makes outbound calls to members, completes ...
Details
Summary
About the job:
assigned hand-dial lists, and provides proactive member support, information, and assistance. Adheres to member interaction departmental standards, call quality, and documentation requirements. Job Duties - Schedules high-quality member appointments daily to meet departmental goals. - Completes assigned hand-dial lists and member research requirements with accuracy and efficiency. - Provides basic support and guidance to members with empathy and professionalism. - Participates in ongoing training sessions to enhance...
Location:
California
Job Type:
Full-Time
Permanent
Occupation:
Customer Service Representatives
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
Affinity Health Plan
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Care Manager, Health Management (Remote)

Affinity Health Plan
Arizona
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JOB DESCRIPTION Job Summary Provides support for health management ...
Details
Summary
About the job:
activities within the care management/care coordination functions. Collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum, including behavioral health, long-term care, and population health-related education and services for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Based on clinical assessment and member...
Location:
Arizona
Job Type:
Full-Time
Permanent
Occupation:
Healthcare Social Workers
Career Level / Education:
Master's degree
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
Affinity Health Plan
Certifications / Licenses:
Certified Case Manager
Licensed Clinical Social Worker
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

RN UM Care Review Clinician Remote

Affinity Health Plan
Arizona
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JOB DESCRIPTION Job Summary The RN Care Review Clinician provides support ...
Details
Summary
About the job:
for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. We are seeking candidates with a RN licensure, Utilization Management knowledge and Medicare Appeals is strongly preferred. Work...
Location:
Arizona
Job Type:
Full-Time
Permanent
Occupation:
Registered Nurses
Career Level / Education:
Bachelor's degree
Salary:
High Income Jobs ($80K-$99K)
From:
Affinity Health Plan
Certifications / Licenses:
Certified Registered Nurse
Certified Professional In Healthcare Management
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information
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