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: The Coordinator-Managed Care works under the supervision of Manager Managed Care. Provides LLEAP Tapestry training to LLUHC Departments. Tracks Bed Day activity, admits, discharges, and Emergency Room services. Approves referral requests within the scope of position, according to health plan criteria and health plan benefit. Arranges for approved home services. Prepares all utilization management (UM) reports. Communicates with out of network facilities. Prepares data required for UM Audits. Cross covers all key areas of utilization management to ensure compliance with regulations. Performs other duties as needed.
Education and Experience: Minimum five years of managed care experience either with a medical group or a managed care organization, with three years focused in utilization management, health plan criteria and benefit interpretation, authorization determination, and all aspects of health plan UM audits required. Must attain a status of LLEAP Tapestry Credentialed Trainer (CT) status within 90 days of starting position, and maintain.
Knowledge and Skills: Knowledge of medical terminology, medical diagnosis and diagnostic procedures required. Knowledge of healthcare regulatory requirements; thorough understanding of all aspects of the current managed care environment. Able to keyboard 40 wpm. Able to use a computer, printer, and software programs necessary to the position (e.g., Word, Excel, Outlook, PowerPoint). Operate/troubleshoot basic office equipment required for the position. Able to work calmly and respond courteously when under pressure; collaborate and accept direction. Able to think critically; manage multiple assignments effectively; organize and prioritize workload; work well under pressure; problem solve; recall information with accuracy; pay close attention to detail; work independently with minimal supervision. Able to distinguish colors as necessary; hear sufficiently for general conversation in person and on the telephone, and identify and distinguish various sounds associated with the workplace; see adequately to read computer screens, and written documents necessary to the position.
Licensures and Certifications: None
Clear All
0 Managed Care Provider Relations Manager jobs found in San Bernardino, CA area