Top 52 Quality assurance lead Jobs in Carlin Nv

Director, Health Plan Provider Contracts (Nevada)
Molina Healthcare, Inc. —Elko, NV
- $102,163 - $199,219 a year
- Full-time
- Office
- 3 years
- Analysis skills
- Health insurance
NGM - Regional Training & Assurance Superintendent
Barrick Gold Corporation —Elko, NV
- Full-time
- 5 years
- Analysis skills
- Mentoring
- Health insurance
- Dental insurance
4d
Operations Experience Manager
Home Depot / THD —Elko, NV
- $54,500 - $64,500 a year
- Overtime
- 18 years or older
- Sales
- Merchandising
Industrial Construction Manager
BBA —Elko, NV
- Full-time
- Construction site
- 11+ years
- Senior level
- Paid holidays
- 401(k)
Principal Consultant, Archaeologist - Nevada
ERM Group —Elko, NV
- $110,624 - $144,756 a year
- Full-time
- Hybrid work
- 6 years
- Construction site
- Driver's License
- AD&D insurance
- Health insurance
7d
Cortez - Senior Hydrologist
Barrick Gold Corporation —Elko, NV
- Full-time
- 5 years
- Microsoft Office
- Bachelor's degree
- Health insurance
- Dental insurance
Fourmile - Cost & Capital Expansion Superintendent
Barrick Gold Corporation —Elko, NV
- Full-time
- 7 years
- CPA
- Office
5d
Hydrogeologist
Jerritt Canyon —Elko, NV
- Full-time
- Bachelor's degree
- Team management
- Senior level
- Health insurance
- Dental insurance
Quick Apply
Senior Geologist
Kinross Gold Corporation —Elko, NV
- Background check
- 18 years or older
- 5 years
- Relocation assistance
Field Technician- Mining Technology
Modular Mining Systems, Inc. —Elko, NV
- $78,500 - $98,100 a year
- Engineering
- Mid-level
- 3 years
Quick Apply
Volunteer AEMT
Elko County —Elko, NV
- Full-time
- CPR Certification
- PALS Certification
- Computer literacy
- Paid holidays
- Dental insurance
Field Service Technician
Rema Tip Top —Elko, NV
- $20 - $24 an hour
- Overtime
- Clean driving record
- Driver's License
- Travel
- Travel reimbursement
- On-the-job training
Quick Apply
Volunteer Paramedic
Elko County —Elko, NV
- Full-time
- CPR Certification
- PALS Certification
- Computer literacy
- Paid holidays
- Dental insurance
Taco Bell Assistant Manager
Taco Bell —Elko, NV
- $16.38 - $19.00 an hour
- Weekends as needed
- 18 years or older
- ServSafe
- Ability to walk for extended periods
- Tuition reimbursement
- Employee assistance program
Quick Apply
Cardiac Cath Lab Radiology Tech
TriHealth —United States
- $17,500 a year
- Full-time
- Anatomy knowledge
- Hospital
- Customer service
- Health insurance
- Dental insurance
Quick Apply
5d
Compounding Pharmacist (Full -Time)Prince Edward Island, Canada
Murphy's Pharmacies PEI —United States
- Full-time
- Mid-level
- Supervising experience
- Continuous improvement
- Relocation assistance
- Dental insurance
Quick Apply
Data Scientist / Data Quality Lead
QL2 Software —United States
- $85 - $150 an hour
- Full-time
- System design
- SQL
- Senior level
3d
Field Superintendent
Five Star Airport Alliance —United States
- $80,000 - $90,000 a year
- Full-time
- Background check
- CPR Certification
- Construction site
- Health insurance
- Dental insurance
Quick Apply
Global Head of Life Sciences
CNA Insurance —United States
- $194,000 - $308,000 a year
- Full-time
- Hybrid work
- 7 years
- Senior level
- Leadership
US LBM Item File Manager
US LBM Holdings —United States
- Full-time
- Mid-level
- Bachelor's degree
- Product management
Quick Apply

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quality assurance lead jobs near carlin nv

Director, Health Plan Provider Contracts (Nevada)

Molina Healthcare, Inc. -
Elko, NV

Apply Now

Job Details

Full-time
$102,163 - $199,219 a year

Benefits

Health insurance

Qualifications

Medicare
Managed care organization experience
Contract management experience in healthcare
Health insurance knowledge
Medicare regulations
Direct contracting
Data interpretation
Contracts
Medicaid regulations
Medicaid
Procurement contract negotiation
Productivity software
Regulatory compliance analysis
Healthcare reimbursement methods
Cross-functional team management
Cross-functional communication
Senior leadership

Full Job Description

JOB DESCRIPTION Job Summary

Leads and directs team responsible for health plan provider network contracting activities. Supports network strategy and development with respect to adequacy, financial performance and operational performance. Collaborates with senior leadership and the corporate network management team to develop and implement standardized provider contracts and contracting strategies. Also responsible for negotiating complex contracts that are strategically critical to plan success, including but not limited to: alternative payment models (APMs), value-based payment (VBP) contracts and capitated payments for hospitals, independent physician associations (IPAs), and complex behavioral health arrangements.

Work Location - Nevada

Essential Job Duties

Oversees the plan’s provider contracting function; responsible for leading the daily operations of the department, and collaborating with other operational departments and functional business unit stakeholders to lead or support various provider contracting functions.
Leads negotiations of contracts with the complex provider community that result in high quality, cost-effective and marketable providers.
Contracts/re-contracts with large scale entities involving custom reimbursement; executes standardized alternative payment model (APM) or value-based payment (VBP) contracts.
Leads initiatives and activities issue escalations, network adequacy, and joint operating committees (JOCs).
Manages and reports network adequacy for Medicare, Marketplace, and Medicaid services.
In conjunction with network leadership, oversees the development of provider contracting strategies including VBP; includes identifying those specialties and geographic locations to concentrate resources for purposes of establishing a sufficient network of participating providers to serve the health care needs of members, in addition to identifying VBP provider targets to meet Molina goals.
Leads the achievement of annual savings through recontracting initiatives, and implements cost-control initiatives to positively influence the medical cost ratio (MCR) in each contracted region.
Leads preparation and negotiations of provider contracts and oversees negotiation of contracts, including VBP, in alignment with established company guidelines for contracting with physicians, hospitals, and other health care providers.
Utilizes standardized contract templates and VBP/pay-for-performance (P4P) strategies.
Develops and maintains reimbursement tolerance parameters (across multiple specialties/ geographies); oversees the development of new reimbursement models in collaboration with senior leadership.
Communicates new contracting strategies to corporate provider network leadership.
Utilizes standardized systems to track contract negotiation activity on an ongoing basis.
Participates on the senior leadership and other committees to address the strategic goals of the department and organization.
Oversees the maintenance of all provider contract templates including VBP program templates; collaborates with legal and corporate network leadership to modify contract templates, and ensures compliance with all contractual and/or regulatory requirements.
Manages the contracting relationships with area agencies and community partners to support and advance plan initiatives.
Develops and implements contracting strategies to comply with state, federal, National Committee for Quality Assurance (NCQA), Healthcare Effectiveness Data Information Set (HEDIS) initiatives and regulations.
Hires, trains, manages and evaluates team member performance - provides coaching, development, and recognition; ensures ongoing appropriate staff training, holds regular team meetings, and drives communication and collaboration.

Required Qualifications

At least 8 years of experience in network contracting with large specialty or multispecialty provider groups, and at least 5 years experience in provider contract negotiations in a managed health care setting ideally negotiating complex provider contract types and value-based payment (VBP) models (i.e. physician/group/hospital), or equivalent combination of relevant education and experience.
At least 3 years of management/leadership experience.
Experience with various managed health care provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to: value-based payment (VBP), fee-for service (FFS), capitation and various forms of risk, etc.
Excellent negotiation and relationship building capabilities.
Ability to navigate complex regulatory environments.
Strong data-driven decision-making skills, and analytical abilities.
Strong organizational skills and attention to detail.
Ability to work cross-functionally with internal/external stakeholders in a highly matrixed organization.
Ability to manage multiple tasks and deadlines effectively.
Excellent verbal and written communication skills.
Microsoft Office suite and applicable software programs proficiency.

Preferred Qualifications

Deep experience negotiating alternative payment models (APMs).
Experience with Medicaid, Medicare, and Marketplace government-sponsored programs.

#PJHPO

#LI-AC1

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Apply Now

Refine Your Search

quality assurance lead jobs in carlin nv

Director, Health Plan Provider Contracts (Nevada)

NGM - Regional Training & Assurance Superintendent

Operations Experience Manager

Industrial Construction Manager

Principal Consultant, Archaeologist - Nevada

Cortez - Senior Hydrologist

Fourmile - Cost & Capital Expansion Superintendent

Hydrogeologist

Senior Geologist

Field Technician- Mining Technology

Volunteer AEMT

Field Service Technician

Volunteer Paramedic

Taco Bell Assistant Manager

Cardiac Cath Lab Radiology Tech

Compounding Pharmacist (Full -Time)Prince Edward Island, Canada

Data Scientist / Data Quality Lead

Field Superintendent

Global Head of Life Sciences

US LBM Item File Manager

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