Top 2930 Plan manager Jobs in Woonsocket, Ri

Contract Manager - Hosp/Physician group exp a plus - Hybrid schedule
Fallon Health —Worcester, MA
- Full-time
- Hybrid work
- Clean driving record
- Research
- Mid-level
Hospice Registered Nurse Case Manager $5k Sign-on bonus, up to 105k/yr - Worcester/ Metro West
New England Hospice —Worcester, MA
- $97,000 - $105,000 a year
- Full-time
- CPR Certification
- Skilled nursing facility
- RN License
- Health savings account
- Health insurance
Quick Apply
2d
Home Care RN Case Manager
Saint Elizabeth Community —Warwick, RI
- Weekends as needed
- CPR Certification
- RN License
- Mid-level
- Mileage reimbursement
- Health insurance
Quick Apply
10d
Millwork Project Manager
Woodcraft Designers & Builders, LLC —Attleboro, MA
- $75,000 - $90,000 a year
- Full-time
- AutoCAD
- Microsoft Outlook
- Construction site
- Paid holidays
- Health insurance
Quick Apply
Tax Manager
Lichtman & Associates, LLC —Wellesley, MA
- $130,000 - $160,000 a year
- Full-time
- Hybrid work
- CPA
- 5 years
- Master's degree
- Profit sharing
- Health insurance
Quick Apply
RN Hospice Case Manager
Hands and Hearts Hospice —Natick, MA
- $90,000 - $110,000 a year
- Full-time
- Nursing
- Vital signs
- RN License
- Mileage reimbursement
- Health insurance
Quick Apply
RN Case Manager - KENT/PROVIDENCE COUNTIES
Amedisys —Warwick, RI
- $85,000 - $98,000 a year
- Full-time
- CPR Certification
- Nursing
- Management
- Wellness program
- Mileage reimbursement
Quick Apply
1d
Special Education Inclusion Gymnastics Program Manager
MSGA —Canton, MA
- $18 - $25 an hour
- Part-time
- Background check
- Experience working with individuals with developmental disabilities
- CPR Certification
- Paid training
- Health insurance
Quick Apply
R&D Manager – Insulin Pump
Dyme Medical —Marlborough, MA
- $140,000 - $160,000 a year
- Full-time
- Bachelor's degree
- In-person
- Senior level
- Health insurance
- Dental insurance
Quick Apply
EXPERIENCED MITIGATION PROJECT MANAGER
Flood Fire Pro Inc —Franklin, MA
- $85,000 - $95,000 a year
- Weekends as needed
- Bilingual
- Clean driving record
- Construction site
- Fuel card
- Health insurance
Quick Apply
1d
Service Manager (Fel-Tech Hammer)
Strongpoint Talent —Worcester, MA
- $80,000 - $85,000 a year
- Full-time
- Management
- Schematics
- Mid-level
- Paid holidays
- Paid time off
Quick Apply
10d
Commercial Project Manager
Installations Plus Inc —Westborough, MA
- Full-time
- Spanish
- Construction site
- English
- Profit sharing
- Fuel card
Quick Apply
9d
District Sales Manager - Northern New York and New England
Hohmann & Barnard, Inc. —Providence, RI
- $88,000 - $132,000 a year
- Email
- Background check
- Microsoft Excel
- Construction site
- Travel reimbursement
- Health savings account
Transportation Safety Manager
Shea's Towing —Cumberland, RI
- $50,000 - $60,000 a year
- Full-time
- Clean driving record
- 5 years
- CDL
- Paid training
- Health insurance
Quick Apply
4d
RN, HOMECARE/HOSPCIE CLINICAL MANAGER, Get Off The Road! Fab BENEFITS & TEAM, To 125k LEX HOURS
New England Personnel, LLC —Northbridge, MA
- $115,000 - $125,000 a year
- Email
- Background check
- Nursing
- Vital signs
- Travel reimbursement
- Free parking
Quick Apply
12h
Pharmacy Manager
Soleo Health Inc —Canton, MA
- $130,000 - $160,000 a year
- Full-time
- Microsoft Outlook
- Patient monitoring
- Patient care
- Health savings account
- Disability insurance
Quick Apply
Clinical Manager (RN)- Home Healthcare- $10,000 Clinical Leadership Bonus
Nightingale Visiting Nurses of Massachusetts —Taunton, MA
- $85,000 - $100,000 a year
- Online Application
- CPR Certification
- Management
- RN License
- Mileage reimbursement
- Health insurance
Clinical Imaging Manager
Shields Health —Dedham, MA
- $77,000 - $148,000 a year
- Full-time
- Management
- Mid-level
- Clinic
Quick Apply
9d
Registered Nurse - Unit Manager
Mount Saint Rita Health Centre —Cumberland, RI
- From $41.45 an hour
- Full-time
- Background check
- Nursing
- Skilled nursing facility
- Free parking
- Health savings account
Quick Apply
8d
Electrical Project Manager
Wayne J. Griffin Electric, Inc —Holliston, MA
- $104,000 - $160,000 a year
- Full-time
- 5 years
- Mid-level
- Office
- Disability insurance
- Health insurance
Quick Apply

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plan manager jobs near woonsocket, ri

Contract Manager - Hosp/Physician group exp a plus - Hybrid schedule

Fallon Health -
Worcester, MA

Apply Now

Job Details

Full-time

Qualifications

Managed care organization experience
Presentations for conferences or internal meetings
Employee relationship building
Driver's License
Computer skills
Stakeholder relationship building

Full Job Description

Overview:

About us:

Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.

Brief Summary of purpose:

Responsible for the analysis, negotiation/renegotiation, implementation, readjustment, evaluation, and continuous improvement of all functions of provider contracting. Manages financial and operational issues related to contractual provider arrangements. Responds to both internal and external customers regarding provider contractual arrangements, both for contract implementation and ongoing operations.

Responsibilities:

Primary Job Responsibilities:

Negotiates, develops and designs contractual provider (Hospital and physician) arrangements including language and pricing methodologies.
Evaluates contractual payment methodologies in order to determine financial risk to insurer and provider (per diem, capitation, discount from charge, DRG, case rate, bundled payments, pay for performance programs, etc.). Ensures the design, production, and distribution of site financial, utilization and member information; ensures the production and completeness of annual site settlement reports. Interfaces between the Plan’s Finance department and individual sites for budget, financial reporting and settlement arrangements for all relevant products.
Performs quantitative analyses of various financial and clinical data in order to evaluate multiple contracting options. Reports on performance of ongoing contractual arrangements to appropriate parties.
Manages, coordinates and resolves operational issues related to specific areas of responsibility. Serves as contact person for internal departments (i.e. Claims, Finance, Care Management Services, Patient Relations, Marketing, Credentialing, Provider Relations, etc.).
Researches, analyzes and presents recommendations to Manager regarding contractual and financial decisions.
Manages provider correspondence relating to contracts and responds to requests from potential new providers for FCHP.
Maintains computerized tracking system for new and revised agreements. Coordinates and communicates contractual information to appropriate departments within FCHP.
Maintains assigned provider network; physician, hospital, ancillary, and/or carve out vendor as assigned by Director or Manager.
Prepares, updates and maintains files and database for all assigned provider contracts.
Serves as committee member in cross-functional teams as assigned by Director or Manager.
Assists in Provider Relations activities including servicing, educating and distributing information to contracted providers.
Analyzes and presents financial reports to providers. Makes recommendations to providers regarding quality and cost improvements.
Other duties as assigned.

Additional Performance Requirements:

Must be a team player with strong relationship building skills.
Must be able to prepare and conduct formal presentations to small and large audiences both internally and externally

Qualifications:

Education:

Bachelor’s degree or equivalent experience required.

Master’s degree in Business Administration, Healthcare Administration, or Public Health preferred. Previous background in nursing or any allied health field is often valuable but not required

License/Certifications

Valid Driver’s License and Clean Driving Record Required

Experience:

Minimum of three years experience in managed healthcare environment(s) with related work in provider contracting, healthcare finance, provider reporting/profiling, and/or provider relations. Experience in provider contract negotiations, including FFS, capitation models, Hospital contracts and pay for performance models is preferred. Excellent analytical, strategic thinking, and creative thinking skills are required. Superior verbal and written skills, excellent computer skills (Word, Excel, Access) are essential to this position.

Pay Range Disclosure:
In accordance with the Massachusetts Wage Transparency Act, the pay for this position is $100,00-$120.000 annually which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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Refine Your Search

plan manager jobs in woonsocket, ri

Contract Manager - Hosp/Physician group exp a plus - Hybrid schedule

Hospice Registered Nurse Case Manager $5k Sign-on bonus, up to 105k/yr - Worcester/ Metro West

Home Care RN Case Manager

Millwork Project Manager

Tax Manager

RN Hospice Case Manager

RN Case Manager - KENT/PROVIDENCE COUNTIES

Special Education Inclusion Gymnastics Program Manager

R&D Manager – Insulin Pump

EXPERIENCED MITIGATION PROJECT MANAGER

Service Manager (Fel-Tech Hammer)

Commercial Project Manager

District Sales Manager - Northern New York and New England

Transportation Safety Manager

RN, HOMECARE/HOSPCIE CLINICAL MANAGER, Get Off The Road! Fab BENEFITS & TEAM, To 125k LEX HOURS

Pharmacy Manager

Clinical Manager (RN)- Home Healthcare- $10,000 Clinical Leadership Bonus

Clinical Imaging Manager

Registered Nurse - Unit Manager

Electrical Project Manager

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