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Neighborhood Health Plan of RI Jobs in Providence

9 jobs

Provides oversight for specific care management or medical review programs/activities and works collaboratively with the Health Care Team to manage and coordinate care in order to ensure quality and cost-effective patient-centered care. He/she supervises a team and ensures delegated work is timely, accurate and delivered on schedule. Responsibilities include, but are not limited to: Engage in on...

Responsible for leading and facilitating the management, contracting, operations, communication, reporting and data exchange for the provider relationship in support of strategic and corporate business objectives. He/she is responsible for managing all operational aspects of the provider relationship for the Medicare/Medicaid members. He/she works collaboratively with business and operational uni...

The role of the Provider Training Specialist is to support Neighborhood’s Medicare/Medicaid product, and specifically the requirements for first tier downstream and related entities (FDR) training. This position develops and updates trainings in line with CMS regulations and pushes training out to Neighborhood’s provider network, as well as monitors and tracks training completion. This is a highly...

This position provides assistance in financial planning, operational analysis and assimilating the company’s entire financial picture. He/she prepares and delivers concept development and communication of financial insights and recommendations to senior leaders. He/she serves as a liaison whereby frequently meeting with internal/external stakeholders to gather requirements for complex analysis, fi...

Performs risk based compliance audits (Fraud, Waste and Abuse, operational, provider network) and delegated entities to ensure compliance with procedures and policies, contracts, laws and regulations and other industry standards. He/she will also consult with management and provide counsel to strengthen the organization's internal control structure and risk management practices. Responsibilities...

This role’s primary responsibility is to provide a highly coordinated, comprehensive approach to Neighborhood’s plan member’s health care needs by providing personalized home-care to members that are in need of more tailored care due to chronic conditions. He/she will manage the care of members in accordance with the Nurse Practitioner standards of care (assessment of health status, diagnosis, dev...

POSITION TITLE:Healthcare EDI Analyst DEPARTMENT: Information Services Overview: The Health Care EDI Analyst is the primary point of contact for system interfaces between Neighborhood and our vendors. The Health Care EDI Analyst has primary responsibility to triage EDI/Interface issues and support operational needs. The Health Care EDI Analyst works directly with business units, our trading par...

Overview: This role requires a Project Manager with strong leadership, communication and analytical skills who is an expert in project management. He/she is responsible for the coordination and completion of projects and oversees all aspects of projects, sets deadlines, assigns responsibilities, and monitors and summarizes progress of projects. The Project Manager prepares reports for management...

This position is the primary point of contact for Encounter Reporting and Processes. He/she has primary responsibility to support State Encounter Submissions, Federal Encounter Submissions and All Payer Claims Database (APCD) submissions. Works directly with business units/delegated entity to ensure compliance and accuracy rates. He/she must be self-directed and solution oriented. He/she will unde...