7 manager contract administration 3 jobs found

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: This role manages the appeal process for members and providers who appeal on behalf of members for Commercial lines of business. Ensures quality management of the clinical appeal process to reduce the risk of State and Federal Regulatory fines and sanctions, avoid adverse exposure, reiterate the expectation of a fair and compliant appeal process for our membership, and support NCQA accreditation and the Divisional Goals for Care Management. We are looking for an experienced clinical leader in the greater Baltimore metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week. ESSENTIAL FUNCTIONS: Develops, establishes and implements a compliant appeal process with dynamic goals resulting in the full and...

Aledade Join Aledade as a Practice Transformation Specialist (PTS) and personally make an impact on patient care. Practice Transformation Specialists are HQ’s most direct interface with providers and can glean valuable insight into our partner practice’s happiness and needs. A successful PTS is passionate about population health, and highly mission oriented around providing better care to patients while reducing costs. At Aledade, a PTS can impact the health of their community by transforming one practice at a time. Please note: candidates must be based in southern Maryland to be considered. Primary Duties: Direct Practice Support: Implement products and execute ACO initiatives with direction from Market Leadership. Accountable for implementing and supporting wellness visits, transitions of care, active management and ensuring practices meet goals set forth in mutually developed Practice Transformation Plans. ACO Training & Development: Work to assist...

Open Systems Technologies Corporation Open Systems Technologies Corporation is looking for an experienced Instructional Designer to provide support to a mission critical program supporting the Intelligence Community. An Instructional Designer ?Workstation? is needed to join a high performing agile team using the Scaled Agile Framework ?SAFe? methodology. We are using Behavior Driven Development ?BDD? and test automation tools alongside a full suite of team collaboration tools. Program execution follows DEVOPS best practices and employs robust development, test, and production environments. The program provides system engineering, development, test, integration, and operational support to a large, fast-paced program, and is infusing new technology and adding advanced capabilities while continuing to support an on-going mission and operational system. The selected candidate will work with an experienced training team to develop and deliver certifiable training for adult learners....

CareFirst BlueCross BlueShield Resp & Qualifications We are looking for an experienced professional in the greater Baltimore/Washington metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week. PURPOSE: This role will lead, guide, strategize and manage negotiations for provider-specific institutional, ancillary, and professional contracts. Key responsibilities include negotiating contract terms in accordance with regulatory requirements, analyzing financial data to evaluate implications across various business lines, while ensuring compliance with company policies and procedures, and coordinating with the Payment Transformation team to transition fee-for-service arrangements to value-based care. This role will also oversee complex projects related to provider...

Transamerica Job Family Corporate Development, Strategy and Sustainability About Us At Transamerica, hard work, innovative thinking, and personal accountability are qualities we honor and reward. We understand the potential of leveraging the talents of a diverse workforce. We embrace an environment where employees enjoy a balance between their careers, families, communities, and personal interests. Ultimately, we appreciate the uniqueness of a company where talented professionals work collaboratively in a positive environment - one focused on helping people look forward and plan for the best life possible while providing tools and solutions that make it easier to get there. Who We Are We believe everyone deserves to live their best life. More than a century ago, we were among the first financial services companies in America to serve everyday people from all walks of life. Today, we're part of an international holding company, with millions of...

Open Systems Technologies Corporation Open Systems Technologies Corporation is looking for a ? Database Engineer/Oracle Database Administrator to join a high performing team providing support to the Intelligence Community. The selected candidate will support a complex system with exacting interface, performance, and security requirements, and will provide database engineering expertise in one or more of the following areas: architecture, design, development, requirements analysis, data flow, network design/implementation, testing, and documentation. She/he will analyze user requirements and system requirements specifications and will develop system architecture and system design documentation. She/he will support the development of system configuration documentation, including designs for capacity and performance planning. The selected individual will perform database engineering activities to include risk assessments and analyses of alternatives for a variety of system related...

CareFirst BlueCross BlueShield Resp & Qualifications CANDIDATES MUST LIVE IN THE MD, DC, NORTHEN VA AREA IN ORDER TO TRAVEL INTO THE OFFICES AND FOR CLIENT MEETINGS AND STAFF MEETINGS. ACTIVE HEALTH AND LIFE LICENSE IS REQUIRED. PURPOSE: This position is a critical resource within the Account Management Team providing consultative expertise on benefits, products, and capabilities. Responsible for promoting new and existing products or services through the development and delivery of tactical marketing and communication initiatives. The Account Manager is directly responsible for aggressively growing group enrollment by marketing to the client's associate base. Builds and maintains effective long-term relationships and a level of satisfaction with key senior-level decision makers and influencers assigned to a group of strategic clients. Creates demand for the organization's products and services by successfully managing the internal and external client...