Managed Care Provider Relations Manager jobs in Green Bay, WI

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)

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RN Care Manager
  • Managed Health Services Wisconsin
  • Carlton, WI FULL_TIME
  • You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. * We are currently offering a $5,000 sign-on bonus for this position * ** This hybrid remote role requires less than 50% travel in Milwaukee / Appleton area and candidates will have the flexibility to work remotely from their home the remaining time ** Position Purpose: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care. • Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options • Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes • Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients • Provide patient and provider education • Facilitate member access to community based services • Monitor referrals made to community based organizations, medical care and other services to support the members’ overall care management plan • Actively participate in integrated team care management rounds • Identify related risk management quality concerns and report these scenarios to the appropriate resources. • Case load will reflect heavier weighting of complex cases than Care Manager I, commensurate with experience • Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems • Direct care to participating network providers • Perform duties independently, demonstrating advanced understanding of complex care management principles. • Participate in case management committees and work on special projects related to case management as needed Education/Experience: Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred. 2 years of clinical nursing experience in a clinical, acute care, or community setting and 1 years of case management experience in a managed care setting. Knowledge of utilization management principles and healthcare managed care. Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs.Licenses/Certifications: Current state’s RN license and a valid driver's license Pay Range: $66,100.00 - $118,900.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

    About the Company:
    Managed Health Services Wisconsin



  • 2 Days Ago

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Respite Care Provider
  • Consumer Direct Care Network
  • Green, WI PART_TIME
  • Job description Enjoy Working with Youth? Then this is the position for you! I am currently recruiting a Respite Worker to work 4-6 hours on the weekends (Saturday or Sunday) with a 12 year old girl w...
  • 5 Days Ago

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Respite Care Provider_DH
  • Consumer Direct Care Network
  • Green, WI PART_TIME
  • Respite care is an excellent way for primary caregivers to get a much-needed break! Consumer Direct Care Network works with the Children's Long-Term Support (CLTS) Program to help children with disabi...
  • Just Posted

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Respite Care Provider Wanted In Green Bay
  • Consumer Direct Care Network
  • Green, WI PART_TIME
  • We are looking for a fun respite provider to be a caregiver out and about in the community during the weekends for about 4 hours per day. Male caregivers encouraged to apply. SHIFTS: 8 Hours per week....
  • 8 Days Ago

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Respite Care Provider for young girl_AP
  • Consumer Direct Care Network
  • Green, WI PART_TIME
  • Respite Provider_AP Location: Green Bay Wage: $10.60 (post taxes) Hours: 8.5 hrs per week Tasks: Supervision Re-direction and Reminders Preferred Qualifications: Caregiving background Strong communica...
  • Just Posted

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Provider Relations Specialist - Marquette, Michigan (Hybrid)
  • Homeward
  • Marquette, MI FULL_TIME
  • The OpportunityWe are seeking a highly motivated Provider Relations Specialist responsible for field activities that educate and support providers in the Homeward service area in the Upper Peninsula o...
  • 2 Days Ago

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0 Managed Care Provider Relations Manager jobs found in Green Bay, WI area

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Enterprise Client Relationship Manager
  • Spectrum
  • Appleton, WI
  • Do you want to build B2B relationships and upsell services to existing clients while earning back former clients? You ca...
  • 5/14/2024 12:00:00 AM

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Email + SMS Strategist
  • Vyper Industrial
  • Green Bay, WI
  • Open Position: Email + SMS Strategist Hours: 8:00 AM - 4:30 PM Monday - Friday Salary: $75,000 - $90,000 / year (dependi...
  • 5/14/2024 12:00:00 AM

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Sales Executive
  • City Lifestyle
  • Green Bay, WI
  • Join the City Lifestyle Team as a Sales Executive City Lifestyle, formerly known as Lifestyle Publications, has been a p...
  • 5/12/2024 12:00:00 AM

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TRUST OFFICER
  • Nicolet National Bank
  • Green Bay, WI
  • At Nicolet National Bank, our culture is based on the principles of community banking, putting the needs of our customer...
  • 5/11/2024 12:00:00 AM

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Territory Sales Manager
  • Schneider
  • Green Bay, WI
  • Job overview: Schneider is seeking a Territory Sales Manager to develop and execute prospecting plans to establish new b...
  • 5/11/2024 12:00:00 AM

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Sales Executive
  • City Lifestyle
  • De Pere, WI
  • Join the City Lifestyle Team as a Sales Executive City Lifestyle, formerly known as Lifestyle Publications, has been a p...
  • 5/11/2024 12:00:00 AM

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Relationship Manager - Corporate Banking
  • Hiring Now!
  • Green Bay, WI
  • At Associated Bank we strive to create an inclusive culture where different perspectives are valued and recognized as st...
  • 5/10/2024 12:00:00 AM

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Management & Sales Training Program (Green Bay)
  • Sherwin-Williams
  • Green Bay, WI
  • The Sherwin-Williams Management & Sales Training Program is an accelerated, entry-level position designed to prepare you...
  • 4/1/2024 12:00:00 AM

Green Bay is a city in and the county seat of Brown County in the U.S. state of Wisconsin, at the head of Green Bay, a sub-basin of Lake Michigan, at the mouth of the Fox River. It is 581 feet (177 m) above sea level and 112 miles (180 km) north of Milwaukee. The population was 104,057 at the 2010 census. Green Bay is the third-largest city in the state of Wisconsin, after Milwaukee and Madison, and the third-largest city on Lake Michigan's west shore, after Chicago and Milwaukee. Green Bay is home to the National Football League's Green Bay Packers. Green Bay is the principal city of the Gree...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Provider Relations Manager jobs
$96,476 to $139,170
Green Bay, Wisconsin area prices
were up 1.3% from a year ago

Managed Care Provider Relations Manager in Atlantic City, NJ
No industry wants to be called inflexible, incompetent, arrogant, greedy, unresponsive, pushy, unethical, or careless, but that's how hospitals and physician groups described managed care companies in a recent survey.
February 11, 2020
Managed Care Provider Relations Manager in Fort Wayne, IN
Brandon Edwards, the head of Davies' healthcare division, says providers would prefer better relationships with payers.
January 08, 2020
Managed Care Provider Relations Manager in Birmingham, AL
Providers "want legitimate, honest P4P programs, data exchange, streamlined business processes, and clarity.
November 28, 2019