Managed Care Provider Relations Manager jobs in Rochester, MN

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
  • Nelson, 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



  • 1 Month Ago

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Children’s Therapeutic Services and Supports Program Manager
  • South Central Human Relations Center, Inc
  • Owatonna, MN FULL_TIME
  • SCHRC is a local mental health clinic that provides a comprehensive range of mental health care services for adults and children. We became a Certified Community Behavioral Health Clinic (CCBHC) in 20...
  • 1 Day Ago

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Children’s Mental Health Case Manager
  • South Central Human Relations Center, Inc
  • Owatonna, MN FULL_TIME
  • Title: Children’s Mental Health Case ManagerDepartment: Family Case Management Reports To: SCHRC Director of Children's Services/Children’s Services Supervisor SUMMARY DEFINITION: The case manager is ...
  • 4 Days Ago

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Youth Respite Provider LB
  • Consumer Direct Care Network
  • Menomonie, WI PART_TIME
  • Do you love helping people? Do you love working with youth and families? Are you compassionate, reliable and have great communication skills? Are you honest, trustworthy, patient and a good role model...
  • 28 Days Ago

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Respite Provider Eau Claire -SK
  • Consumer Direct Care Network
  • Mound, WI PART_TIME
  • Family: Child: Young girl City of Residence: Eau Claire Schedule: 6 overnights a month Additional 5 hours per week on occasion Pay: $246.75 per overnight $16.80 per additional hour Location Position i...
  • 22 Days Ago

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Respite Provider Eau Claire -SK
  • Consumer Direct Care Network
  • Menomonie, WI PART_TIME
  • Location Eau Claire WI Position in Providers Home and Community Family: Child: Young girl Schedule: 6 overnights a month Additional 5 hours per week on occasion Pay: $16.80 per additional hour $246.75...
  • 23 Days Ago

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0 Managed Care Provider Relations Manager jobs found in Rochester, MN area

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Fire Sprinkler Sales Project Manager
  • Ahern
  • Rochester, MN
  • Looking to join one of the best mechanical and fire protection contractors in the United States? Join our team! Ahern ha...
  • 4/24/2024 12:00:00 AM

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ADMINISTRATIVE ASSIS
  • GLS Industries
  • Rochester, MN
  • Job Description Job Description Job Description: Front Desk Administrative Assistant Position Overview: We are seeking a...
  • 4/24/2024 12:00:00 AM

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Assistant Store Manager (ASM) Rochester MN
  • Holiday Station Stores - Workday
  • Rochester, MN
  • Store 2746427: 919 37th Street NW, Rochester, Minnesota 55901 Availability - Shift/Days Flexible Availability This is a ...
  • 4/22/2024 12:00:00 AM

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Travel Interventional Radiology Technologist - $2,904 per week
  • TRS Healthcare
  • Rochester, MN
  • Springboard Healthcare is seeking a travel Interventional Radiology Technologist for a travel job in Rochester, Minnesot...
  • 4/21/2024 12:00:00 AM

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Entry level- Wealth Management Associate
  • Equitable Advisors
  • Rochester, MN
  • Equitable Advisors is a respected wealth management firm with a proven track record in the industry. We are driven by ou...
  • 4/21/2024 12:00:00 AM

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Quality Engineer
  • Crenlo Engineered Cabs
  • Rochester, MN
  • SUMMARY: Direct responsibility for quality control and assurance activities within the plant, including, but not limited...
  • 4/20/2024 12:00:00 AM

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Entry level- Wealth Management Associate
  • Equitable Advisors
  • Rochester, MN
  • Equitable Advisors is a respected wealth management firm with a proven track record in the industry. We are driven by ou...
  • 4/20/2024 12:00:00 AM

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Concierge - Supplemental
  • Mayo Clinic Health System
  • Rochester, MN
  • Why Mayo Clinic Mayo Clinic is top-ranked in more specialties than any other care provider according to U.S. News & Worl...
  • 4/20/2024 12:00:00 AM

Rochester is a city founded in 1854 in the U.S. State of Minnesota and is the county seat of Olmsted County located on the Zumbro River's south fork in Southeast Minnesota. It is Minnesota's third-largest city and the largest city located outside the Minneapolis-St. Paul Metropolitan Statistical Area. As of 2015, the Rochester metropolitan area has a population of 215,884. According to the 2010 United States Census the city has a population of 106,769. The U.S. Census Bureau estimated that the 2017 population was 115,733. It is the home of the Mayo Clinic and an IBM facility, formerly one of t...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Provider Relations Manager jobs
$101,201 to $145,983
Rochester, Minnesota 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