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)
PROGRAM: Mental Health Rehabilitation
REPORTS TO: Clinical Manager (LMHP)
SUPERVISED BY: Regional Manager; Regional and agency Clinical Manager (LMHP); Corporate Compliance Officer
RESPONSIBILITIES:
Provide Strength-based, solution-focused supportive therapeutic services in the community.
Provide consumer driven and family oriented services, conducted within the context of the consumers’ natural environment.
Provides client-centered, individual Psychosocial Skills Rehabilitation (PSR) services in the community.
Be knowledgeable of your clients including their strengths, diagnosis, treatment goals and treatment plan.
Assess each recipient for Strengths, Resources, and Goals within first 30 days of treatment; provide Strength-based planning and treatment on an ongoing basis.
Assist with 90 Day reviews
Participate in collaborative meetings with Rehabilitation Services staff, other agencies or community and natural supports as needed.
Provide Crisis Intervention services to recipients as needed according to agency policies, procedures, and service definitions.
Communicate client’s status on a regular basis, including, but not limited to changes in mood or functioning, medical issues
and all crisis and health and safety issues.
Be knowledgeable of and adept at producing effective, clinical documentation of every contact with recipient.
Turning in notes on time according to policy. Document all “no shows,” and communicate all difficulties contacting clients with appropriate office staff.
Be able, or willing to learn, to use computer interface to complete documentation for billing or other purposes as needed.
Attend all office trainings as well as regular clinical supervision sessions with Clinical Manager and/or Team Manager.
Document services provided regularly, concisely, and completely in accordance with clinical standards by office deadline.
Return phone calls promptly
Follow all safety rules
Obtain 20 training hours as required for a full time MHP or 16 training hours as required for a part time MHP yearly
Actively participate in all evaluations conducted by Rehabilitation Services
MINIMUM QUALIFICATIONS:
Has a Master’s Degree from an accredited university or college in the field of:
o Counseling,
o Social Work,
o Psychology or
o Sociology
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