Provider Partners Health Plan

Benefit Support Advocate

Provider Partners Health Plan · Full Time · 7 days ago

Provider Partners Health Plan

🌎 Worldwide ⭐ 2-5 yrs exp 💼 Support

The Advocate coordinates medical appointments and procedures for members in ISNP and IESNP plans by collaborating with long-term care facilities and providers. They are responsible for initiating authorization processes and ensuring all scheduling details are accurately communicated and documented.

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Credentialing Coordinator- Temporary

Provider Partners Health Plan · Part Time · 8 days ago

Provider Partners Health Plan

🌎 Worldwide ⭐ 2-5 yrs exp 💼 Others

The role involves credentialing practitioners for network participation and maintaining accurate provider data within Salesforce. It also includes auditing delegated entities to ensure compliance with CMS and NQA standards.

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Clinical Administrative Coordinator

Provider Partners Health Plan · Full Time · a month ago

Provider Partners Health Plan

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

The Clinical Administrative Coordinator provides essential administrative and clerical support to the clinical management team to ensure efficient operations. Responsibilities include scheduling appointments, facilitating member surveys, and acting as a liaison between internal departments and external partners.

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Benefits Support Specialist

Provider Partners Health Plan · Full Time · a month ago

Provider Partners Health Plan

🌎 United States ⭐ 2-5 yrs exp 💼 Support

The Benefits Support Specialist educates long-term care facilities and members about supplemental benefits while managing engagement and utilization. The role involves traveling to nursing homes, facilitating outreach programs, and maintaining compliance with company policies.

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Partner Engagement Analyst- ACO

Provider Partners Health Plan · Full Time · 2 months ago

Provider Partners Health Plan

🌎 United States ⭐ 2-5 yrs exp 💼 Others

The Partner Engagement Analyst will analyze ACO REACH partners' performance and identify opportunities for improvement while serving as the primary point of contact for assigned partners. Responsibilities include facilitating meetings, providing customer service, and generating performance reports.

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A&G Coordinator

Provider Partners Health Plan · Full Time · 3 months ago

Provider Partners Health Plan

🌎 Worldwide ⭐ 2-5 yrs exp 💼 Others

The A&G Coordinator supports compliance by assisting with record and report reviews and serving as the primary liaison for Appeals and Grievances communications between internal and external stakeholders. This role also assists the A&G Auditor with oversight activities and executes basic administrative duties using reporting and database systems.

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Pharmacy Business Analyst

Provider Partners Health Plan · Full Time · 3 months ago

Provider Partners Health Plan

🌎 Worldwide ⭐ 2-5 yrs exp 💼 Software Development

The analyst will focus on analyzing pharmacy utilization, claims data, and cost trends to identify savings opportunities and support the development of pharmacy benefit strategies. Key duties include managing reporting tools, optimizing the drug formulary, and ensuring adherence to CMS Medicare Advantage regulations.

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Chief Clinical Officer

Provider Partners Health Plan · Full Time · 3 months ago

Provider Partners Health Plan

🌎 Worldwide ⭐ 10+ yrs exp 💼 Healthcare

The Chief Clinical Officer is responsible for setting and executing the clinical vision for the organization’s Medicare Advantage I-SNP/IE-SNP, focusing on high-quality, person-centered care, driving risk adjustment accuracy, and managing affordability. This role provides strategic direction over clinical programs, quality initiatives, and care delivery models to improve health outcomes and ensure sustainable financial performance.

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Provider Relations Coordinator

Provider Partners Health Plan · Full Time · 3 months ago

Provider Partners Health Plan

🌎 United States ⭐ 2-5 yrs exp 💼 Others

The Provider Relations Coordinator acts as a liaison to support the provider network, focusing on onboarding, contract administration, and resolving provider inquiries regarding claims and reimbursements. Key duties include managing provider data accuracy, facilitating internal and external communication, and ensuring compliance with regulatory requirements.

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