Configuration Management Analyst (44246)
Smithfield, Rhode Island
Neighborhood Health Plan of Rhode Island
Description The Configuration Management Analyst is an entry to mid- level position responsible for the analysis, design, build, testing, implementation, and maintenance of system configuration to support business requirements and optimize ...
2h
| Job Type | Full Time |
Credentialing Representative (44299)
Smithfield, Rhode Island
Neighborhood Health Plan of Rhode Island
Description This position is responsible for processing provider application for network entry and reappointment, including primary source verification of providers credentials according to Plans policy, NCQA standards and regulatory requir...
2h
| Job Type | Full Time |
Clinical Program Manager (44429)
Smithfield, Rhode Island
Neighborhood Health Plan of Rhode Island
Description The Clinical Program Manager is responsible for the strategic design, implementation, and ongoing management of clinical programs within the health plan to improve quality, member outcomes, regulatory compliance, and cost-effect...
2h
| Job Type | Full Time |
Enrollment Representative (44382)
Smithfield, Rhode Island
Neighborhood Health Plan of Rhode Island
Description Under direct supervision, is responsible for a variety of specific functions associated with enrollment and reconciliation transactions to facilitate accurate enrollment data. He/she processes enrollment data within a timeframe ...
2h
| Job Type | Full Time |
Clinical Operations Pharmacist (44572)
Smithfield, Rhode Island
Neighborhood Health Plan of Rhode Island
Description The Clinical Operations Pharmacist works in conjunction with the Clinical Program Pharmacist and Medical Management teams to review medication utilization and develop/implement initiatives to ensure appropriate drug therapy prio...
2h
| Job Type | Full Time |
Claim Auditor Payment Integrity (44544)
Smithfield, Rhode Island
Neighborhood Health Plan of Rhode Island
Description The Claim Auditor in Payment Integrity will address problematic and complex audit assignments to identify claim overpayments in accordance with established billing and coding parameters. Claim payment accuracy will be recognized...
2h
| Job Type | Full Time |
Senior Provider Reimbursement Analyst (43439)
Smithfield, Rhode Island
Neighborhood Health Plan of Rhode Island
Description The Senior Provider Reimbursement Analyst is responsible for development and management of fee schedules, including sample schedules, and alternative payment methodologies (APM) that support strategic and corporate goals. This p...
2h
| Job Type | Full Time |
Smithfield, Rhode Island
Neighborhood Health Plan of Rhode Island
Description The Medical Director is to provide clinical leadership and consultation to the Plan's various departments with the goal of promoting clinical excellence, quality care in our provider network, as well as maximizing member access ...
2h
| Job Type | Part Time |
Manager of Configuration Services (44064)
Smithfield, Rhode Island
Neighborhood Health Plan of Rhode Island
Description The Manager of Configuration Services ensures that the performance, function, and appearance of our products are consistent in our claims system(s). This involves managing the requirements, design and operational information thr...
2h
| Job Type | Full Time |
Integrated Care Manager (44285)
Smithfield, Rhode Island
Neighborhood Health Plan of Rhode Island
Description The Integrated Care Manager (ICM) works collaboratively with the integrated care team to manage and coordinate care for a specific population of members whose needs represent high clinical and social risk in order to ensure qual...
2h
| Job Type | Full Time |