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)
Are you looking for a career to be a part of a great culture of support and growth? Then welcome you made it to the job posting for you!
At Nevada Health Centers, we look for people who will embrace our vision of excellent service. Who have the desire to serve and make a difference in our communities. We value as an organization diversity and inclusion. If you can see yourself here and can deliver a positive impact, then check out some of the details below!
The Provider Relations Manager maintains the provider network with all NVHC payers and oversees contract coordination, credentialing, privileging, and provider enrollments for the medical, behavioral health, residents, pharmacy, dental providers, and all clinical staff. This position will work closely with all providers and clinical staff to obtain all information necessary to complete credentialing and privileging requirements; coordinates hospital applications and re-appointments for providers as needed; maintains current credentials for all active providers; complies with all HIPAA and HRSA rules and regulations. Furthermore, the Provider Relations Manager oversees the coordination, compilation, and preparation of reports pertaining to existing practitioners as requested; prepares all correspondence associated with the credentialing and reappointment process; provides verification of employment and malpractice coverage for all medical and dental providers.
Credentialing and Privileging
Provider/Clinical Staff Contracting
Provider Relations
Risk Management
Requirements:
About our company:
Established in 1977, Nevada Health Centers is the largest provider of primary care for the uninsured, underinsured, and geographically isolated, with 18 health centers; three mobile health programs; and seven Women, Infants, and Children offices. Our mission: To provide access to quality healthcare services throughout Nevada. Our vision: To create an integrated, provider-led healthcare system that supports the delivery of safe, effective, quality-based primary care to all Nevadans.
Nevada Health Centers will provide equal opportunity employment to all employees and applicants for employment. No person shall be discriminated against in employment because of race, color, gender, age, national origin, ancestry, religion, physical or intellectual disability marital status, parental status, sexual orientation or any other category protected by law.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee is occasionally required to stand; walk; stoop, kneel, or crouch. The employee must regularly lift and/or move up to 20 pounds.
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