Health Plan Operations

A New Approach to Health Plan Operations | PR Newswire | 9/23/2020

TAMPA, Fla. , Sept. 23, HealthAxis takes health plan claims administration software and services to the next level with the release of HxOne; an end-to-end, fully integrated healthcare operations solution. HxOne combines advanced claims system technology, flexible front and back-office services, and actionable analytics. The HxOne encompasses: (PRNewsfoto/HealthAxis) HxPro, a next-generation, claims administration platform that helps streamline healthcare claims processing and health plan management. HxOps, a …

ClarisHealth Launches A.I. Powered Healthcare Fraud Detection Solution for Health Plans | 9/10/2020

ClarisHealth, the company transforming health plan operations with its comprehensive payment integrity technology platform Pareo, launched an artificial intelligence-based (A.I.) solution for healthcare fraud detection. Pareo Fraud Detection works seamlessly with Pareo Fraud Case Management for an integrated, 360-degree approach to mitigating fraud, waste, and abuse (FWA). According to Mark Isbitts , vice president of program integrity for ClarisHealth, who led the project, Pareo Fraud Detection provides significant advantages …

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ClarisHealth Launches A.I. Powered Healthcare Fraud Detection Solution for Health Plans | PRWeb | 9/9/2020

… will get information on which providers to investigate first, why a provider is suspicious, and how valuable the investigation can be – in real-time. NASHVILLE, Tenn. (PRWEB) September 09, 2020 ClarisHealth, the company transforming health plan operations with its comprehensive payment integrity technology platform Pareo®, launched today an artificial intelligence-based (A.I.) solution for healthcare fraud detection. Pareo Fraud Detection works seamlessly with Pareo Fraud Case Management for an integrated …

Sentara, Cone Health to form $11.5B system | Becker’s Hospital Review | 8/12/2020

… Optima Health Plan and Virginia Premier Health Plan, which serve 858,000 members, while Cone Health runs a Medicare Advantage plan with 15,000 members. Mr. Akin said the health systems plan to eventually combine their health plan operations . The deal, which is subject to regulatory approval, is expected to close in mid-2021. Mr. Kern and Mr. Akin said merger discussions began about a year ago, but slowed at some points …

DataLink’s Evoke360 Automates Data Extraction from Electronic Health Records to Continuity of Care Document files, Closes Care Gaps and Improves Payer and Provider Connectivity | Business Wire | 8/11/2020

… payer and provider. Giarth adds, “Our nation’s healthcare systems need what Evoke360 offers: optimized care quality, reduced administrative burden, enhancements for value-based care and improved financial performance and communication, with visibility into all health plan operations in one point-of-care solution.” About DataLink Software DataLink Software (DataLink) is a healthcare technology company that empowers better health by enabling payers, providers and risk-bearing entities with real-time data …

VP, Employer Sales | 8/6/2020

… Develop broker marketing strategies and materials. Responsible for sales call center stand-up and execution as well as the broker service unit for Self-funded sales. Assist with product design, marketing, new technology products, health plan operations . This position has supervisory responsibilities for the Self-funded Distribution team. EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE Bachelor’s degree required, Graduate degree preferred or fifteen (15) years of experience in self-funded sales and …

Clever Care of Golden State Receives Knox-Keene License From California Department Of Managed Health Care | PRWeb | 7/29/2020

… launch Medicare Advantage products this Fall to serve Medicare eligible enrollees in Southern California” said Dave Firdaus, CEO of Clever Care Health Plan . The DHMC is the state regulatory agency that oversees California HMO health plan operations to ensure that health care service plans provide enrollees with access to quality health care services and protect and promote the interests of enrollees. It grants health service plans with the license under …

Peter Janelle Joins Vital Data Technology as Director of Risk Adjustment Solutions | PR Newswire | 6/30/2020

… has joined the company as Director of Risk Adjustment Solutions. Peter brings a decade of experience working with health plans as they developed and implemented their risk adjustment strategies and programs. His expertise in health plan operations and risk adjustment programs and extensive knowledge of Medicare Advantage finance, including risk adjustment, Star, value-based arrangements, and healthcare economics will drive value both for Vital Data Technology and its clients. “Vital …

Medicare Advantage plans face ‘double whammy’ of pent-up care demand and risk scores: experts | FierceHealthcare | 6/5/2020

… then could be faced with higher healthcare costs due to pent-up demand from delayed care. “You see a double whammy with the impact of risk scores,” said David Weathington, senior vice president of health plan operations for Clover Health, during the virtual series. RELATED: Half of physicians now using telehealth as COVID-19 changes practice operations After the SARS epidemic in the early 2000s, over the next 6 to …

UCare: Business Reporting Analysis Senior - EDI | Star Tribune | 3/31/2020

… limited to BusinessObjects and SQL • Other projects and duties as assigned. Education Bachelor’s degree in business, IT or related field; demonstrated experience may be considered. Required Experience Seven years of business analysis experience within health plan Operations or IT. Five years of data analysis experience. Five years of experience in report development, including SQL queries. Experience working with business experts to evaluate complex data requirements. Preferred Experience Health Plan Operations

Rvp Medicaid East Regional Ops - USA-FL-Fort Lauderdale | 3/27/2020

Profile RVP Medicaid East Regional OpsThe candidate will be responsible for leading and directing Regional Operations areas of a Medicaid Region in East Central or West. Oversight of the Health Plan operations strategies for the Region, as well as initiatives. Primary duties may include, but are not limited to: Oversees Health Plan Operational leads, as well as Regional Operations pillars, currently including: 1.Provider Oversight and Execution Team. 2.Escalated …

Health Plan Operations Transportation Coordinator - Metairie, LA - UnitedHealth Group - Metairie, LA | 3/15/2020

… of Transportation Vendor claims Possess strong attention to detail with the ability to think in a logical and structured manner to identify problems and present solutions for consideration Complete research as needed by the Health Plan Operations team analyzing and composing data into a useable format. Leverage strong communication skills (verbal, non-verbal, and written) with a demonstrated ability to communicate ideas clearly and concisely with peers, superiors, members, and …

Senior Analyst - RMHP/UHC C&S - Grand Junction, CO (telecommute option) - UnitedHealth Group - Grand Junction, CO | 3/6/2020

… anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: Conduct research, statistical, and analytical studies as directed on health plan data to fulfill internal and external reporting requirements related to health plan operations and a variety of health plan related issues Interpret and analyze information, conduct cost benefit analyses, and financial assessments to be used in business planning. Provide pros and cons of various potential options …

(USA) VP & GM - Accountable Care (Health Plan Operations) | 12/19/2019

… delivering the highest possible quality and value health care in partnership with the faculty of the School of Medicine and Stanford Children’s Health, Stanford Health Care. The Vice President (VP) is responsible for leading Health Plan Operations reporting to the Chief Financial Officer of Stanford Health Care. The VP will partner with colleagues in finance, clinical services, operations and corporate health care services to deliver health care offerings to the …

Kaiser Permanente mental health clinicians launch 5-day strike | Becker’s Hospital Review | 12/16/2019

… 11 to Nov. 15 but was rescheduled for Dec. 16 to Dec. 20 after the death of Kaiser Chairman and CEO Bernard J. Tyson. Michelle J. Gaskill-Hames, senior vice president of hospital and health plan operations for Kaiser Permanente Northern California, told The Sacramento Bee Kaiser has made proposals that would provide excellent benefits, keep Kaiser therapists among the highest paid in the state, and provide workers with more …

Kaiser mental health workers start five-day strike – The San Francisco Examiner | 12/16/2019

… overwhelmed with unsustainable caseloads. Kaiser mental health workers previously went out on a five-day strike in December last year. In a statement Friday, Michelle J. Gaskill-Hames, senior vice president of hospital and health plan operations for Kaiser Permanente Northern California, said Kaiser has been working with an external, neutral mediator to help us reach a collective bargaining agreement with the NUHW. That mediator, Gaskill-Hames said, recently delivered …

(USA-LA-Metairie) Health Plan Operations Transportation Coordinator - Metairie, LA | 12/12/2019

Job Information UnitedHealth Group Health Plan Operations Transportation Coordinator - Metairie, LA in Metairie , Louisiana Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life’s best work. Let’s face it, no industry is moving faster than health care. And no organization …

Evolent Health Partner Passport Health Plan is Not Initially Selected for Kentucky Managed Medicaid Contract – Company Announcement - FT.com | Financial Times | 11/27/2019

… than 22 years and is a recognized leader in providing outstanding service and high quality care to its members. Evolent and Passport formed an initial partnership in 2016 and Evolent currently provides support in health plan operations , clinical programs and specialty care management for Passport’s 300,000 members. Earlier in 2019, Evolent agreed to purchase a 70 percent ownership stake in Passport in partnership with University of Louisville and several other …

Evolent Health Partner Passport Health Plan is Not Initially Selected for Kentucky Managed Medicaid Contract | Markets Insider | Business Insider | 11/27/2019

… than 22 years and is a recognized leader in providing outstanding service and high quality care to its members. Evolent and Passport formed an initial partnership in 2016 and Evolent currently provides support in health plan operations , clinical programs and specialty care management for Passport’s 300,000 members. Earlier in 2019, Evolent agreed to purchase a 70 percent ownership stake in Passport in partnership with University of Louisville and several other …

Evolent Health Partner Passport Health Plan is Not Initially Selected for Kentucky Managed Medicaid Contract | PR Newswire | 11/27/2019

… than 22 years and is a recognized leader in providing outstanding service and high quality care to its members. Evolent and Passport formed an initial partnership in 2016 and Evolent currently provides support in health plan operations , clinical programs and specialty care management for Passport’s 300,000 members. Earlier in 2019, Evolent agreed to purchase a 70 percent ownership stake in Passport in partnership with University of Louisville and several other …

Evolent Health Partner Passport Health Plan is Not Initially Selected for Kentucky Managed Medicaid Contract | PR Newswire | 11/27/2019

… than 22 years and is a recognized leader in providing outstanding service and high quality care to its members. Evolent and Passport formed an initial partnership in 2016 and Evolent currently provides support in health plan operations , clinical programs and specialty care management for Passport’s 300,000 members. Earlier in 2019, Evolent agreed to purchase a 70 percent ownership stake in Passport in partnership with University of Louisville and several other …

(USA-WA-Bothell) Specialist, Provider Appeals & Disputes | 11/27/2019

Molina Healthcare Specialist, Provider Appeals & Disputes in Bothell , Washington Job Description Job Summary Molina Health Plan Operations jobs are responsible for the development and administration of our State health plan’s operational departments, programs and services, 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 Inquiry/Services staff are responsible for the submission, research, and resolution …

(USA-OH-Columbus) Rep, Provider Appeals & Disputes | 11/27/2019

Molina Healthcare Rep, Provider Appeals & Disputes in Columbus , Ohio Job Description Job Summary Molina Health Plan Operations jobs are responsible for the development and administration of our State health plan’s operational departments, programs and services, 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 Inquiry/Services staff are responsible for the submission, research, and resolution …

(USA-WA-Bothell) Specialist, Provider Inquiry R | 11/27/2019

Molina Healthcare Specialist, Provider Inquiry R&R in Bothell , Washington Job Description Job Summary Molina Health Plan Operations jobs are responsible for the development and administration of our State health plan’s operational departments, programs and services, 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 Inquiry/Services staff are responsible for the submission, research, and …

(USA-CA-Long Beach) Manager, Provider Inquiry Research & Resolution | 11/27/2019

Molina Healthcare Manager, Provider Inquiry Research & Resolution in Long Beach , California Job Description Job Summary Molina Health Plan Operations jobs are responsible for the development and administration of our State health plan’s operational departments, programs and services, 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 Inquiry/Services staff are responsible for the submission, research …