Managed Care Provider Relations Manager develops, manages, and sustains relationship with members of physician network of managed care service providers. Recruits new physicians and manages the credentialing and orientation process. Being a Managed Care Provider Relations Manager serves as a resource for physicians, answering questions and providing information about network procedures or contracts. Monitors provider performance and resolves any issues. Additionally, Managed Care Provider Relations Manager reviews billings and claims payments according to managed care contracts. Requires a bachelor's degree. Typically reports to the head of a unit/department. The Managed Care Provider Relations Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Managed Care Provider Relations Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)
Job Summary
Responsible for managed care portfolio performance for assigned payors. Work with Management on implementation of contracting strategy for the System. Independently negotiate contract language and rates for minor payors, or major payors when the scope of the negotiation is limited. Negotiate payor agreements with Director/AVP support. Monitor contract performance versus expected, and recommend any action needed.
Essential Functions
Physical Requirements
Perform most work under normal office conditions; may include sitting for long periods of time, standing, walking, using repetitive wrist/arm motion or lifting articles up to twenty-five pounds.
Education, Experience and Certifications
Bachelor's degree required, Master's degree preferred (MBA or MHA preferred). Minimum of 3 years experience as a contract negotiator with a large provider or 5 years small provider or payor experience as a contract negotiator with a Bachelor's degree. -OR- Minimum of 2 years experience as a contract negotiator with a large provider or 4 years small provider or payor experience as a contract negotiator with a Master's degree.
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0 Managed Care Provider Relations Manager jobs found in Charlotte, NC area