Managed Care Provider Relations Manager jobs in Tampa, FL

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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MANAGED CARE CONTRACT MANAGER
  • Moffitt Cancer Center Careers
  • Tampa, FL FULL_TIME
  • At Moffitt Cancer Center, we strive to be the leader in understanding the complexity of cancer and applying these insights to contribute to the prevention and cure of cancer. Our diverse team of over 9,000 are dedicated to serving our patients and creating a workspace where every individual is recognized and appreciated. For this reason, Moffitt has been recognized on the 2023 Forbes list of America’s Best Large Employers and America’s Best Employers for Women, Computerworld magazine’s list of 100 Best Places to Work in Information Technology, DiversityInc Top Hospitals & Health Systems and continually named one of the Tampa Bay Time’s Top Workplace. Additionally, Moffitt is proud to have earned the prestigious Magnet® designation in recognition of its nursing excellence. Moffitt is a National Cancer Institute-designated Comprehensive Cancer Center based in Florida, and the leading cancer hospital in both Florida and the Southeast. We are a top 10 nationally ranked cancer center by Newsweek and have been nationally ranked by U.S. News & World Report since 1999.
    Working at Moffitt is both a career and a mission: to contribute to the prevention and cure of cancer. Join our committed team and help shape the future we envision.

    Summary

    Managed Care Contract Manager

    Position Highlights:

    • The Managed Care Contract Manager is responsible for analyzing, negotiating and maintaining system-wide Managed Care agreements consistent with Moffitt Cancer Center Guidelines.
    • The Managed Care Contract Manager is responsible for managing payer relationships, negotiation of reimbursement rates and contract language, communication and education of contract terms and conditions to appropriate internal parties, researching and resolving managed care related issues, and the analysis of contract performance to expectations.
    • This position will serve as a critical resource in supporting, managing and driving strategic projects; and the development and execution of key business strategies for Moffitt Cancer Center managed and value-based care portfolio.

    Responsibilities:

    • Develops, negotiates, administers, and maintains system-wide managed care agreements, including but not limited to, physician, hospital, delegated credentialing and transplant Agreements consistent with Moffitt guidelines and under the direction of the Director of Managed Care.
    • Develops and maintains relationships with internal matrix partners and external payer partners.
    • Develops strategies, contract language and evaluates financial impact of agreements in alignment with Director of Managed Care.  
    • Ensuring that Moffitt policies and procedures related to delegated physician credentialing are acceptable to managed care plans. Ensuring that provider status is accurate with all plans.
    • Analyze the managed care environment; monitor and communicate trends in national, regional, and local markets.
    • Responsible for researching, tracking, trending, and resolving managed care related revenue cycle problems between Moffitt and managed care plans.  This includes monitoring changes in managed care plan authorization and payment policies and serving as the point person to proactively challenge unfavorable policies with the applicable payer.  
    • The Managed Care Contract Manager will work with the Revenue Cycle Departments to resolve systemic managed care payment problems and serve as the point person for enforcing the terms of our managed care contracts.
    • Evaluates possible reimbursement methodologies and business initiatives in view of their relevance and marketability to payers.
    • Analyzes and monitors the financial impact of new and existing managed care agreements in conjunction with the Director of Managed Care.
    • Identifies opportunities to gain efficiencies and greater effectiveness in contracts. 
    • Supports Moffitt growth strategies by being a subject matter expert on payment implications for new opportunities.
    • Assists various Moffitt Departments with resolving patient access issues related to patient insurance.
    • Provides support to individual patient Letters of Agreement with non-contracted payers as needed. 
    • Serves as the Managed Care Department’s liaison within Moffitt and as an organization wide resource for managed care related issues.
    • Resolves issues that arise between Moffitt and managed care organizations.
    • Provides appropriate physician and staff education to support the managed care activities of Moffitt.

    Credentials and Experience:

    • Bachelor’s Degree – field of study: Healthcare, Finance or related field
    • Minimum five (5) years of progressively challenging experience in managed care contracting, either in a hospital, health system, or managed care organization. 

    Skills:

    • Skill in composing and editing documents to include contracts, correspondence, and reports. 
    • Demonstrated skill in evaluating, monitoring, and improving existing contracts. Proven ability to resolve managed care revenue cycle related issues. 
    • Comprehensive knowledge and understanding of managed care principles and practices, experience in fee for service and value based payment models in hospital, physician and transplant provider types.
    • Demonstrated track record of success in negotiating with third parties including preparation and design of the negotiation as well as execution. 
    • Proven ability to prepare and present managed care strategies for team, stakeholders and leadership. High proficiencies  with Microsoft tools (primarily Word, Excel and Power Point). 
    • Demonstrated analytical skills, including financial modeling and reimbursement technologies, proficient in spreadsheet and database programs as well as legal and contractual compliance issues.
    • Excellent written and oral and presentation skills.  Excellent interpersonal and problem solving skills.  
    • Demonstrated success in building positive and effective relationships with physicians, leadership, and team members.  Ability to work effectively in a matrix organizational model. Must be able to work and communicate effectively with all levels of management and staff.
    • Knowledge of both payer and hospital/physician managed care operations
    • Demonstrated knowledge of Federal and State Regulations, including Medicare, Medicaid, and ERISA. Must have significant experience redlining Managed Care Agreements.
  • 28 Days Ago

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Managed Care Contract Manager
  • Shriners Hospitals For Children
  • Tampa, FL FULL_TIME
  • ID 2024-4647 Category Payer Relations Position Type Regular Full-Time Company Overview Shriners Children’s Hospital is an organization that respects, supports, and values each other. We are engaged in...
  • 1 Month Ago

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Managed Care Contract Manager
  • Shriners Children's
  • Tampa, FL FULL_TIME
  • Company Overview Shriners Children’s Hospital is an organization that respects, supports, and values each other. We are engaged in providing excellence in patient care, embracing multi-disciplinary ed...
  • 1 Month Ago

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Managed Care Billing Specialist
  • Southwest Florida Home Care, Inc.
  • Tampa, FL FULL_TIME
  • : MANAGED CARE BILLING SPECIALIST Perform initial audit on all charts within 24hours of QA approval To follow up on and/or correct any issues found upon initial review in a timely manner Run a daily d...
  • 9 Days Ago

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Dental assistant
  • Centurion Managed Care
  • Bowling Green, FL FULL_TIME
  • Job Details Description Centurion is proud to be the provider of dental services to the Florida Department of Corrections. We are currently seeking a full-time Dental Assistant to join our team at Har...
  • 1 Month Ago

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Hospital Managed Care Contractor
  • Shriners Children's
  • Tampa, FL CONTRACTOR
  • Company Overview Shriners Children’s Hospital is an organization that respects, supports, and values each other. We are engaged in providing excellence in patient care, embracing multi-disciplinary ed...
  • 19 Days Ago

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0 Managed Care Provider Relations Manager jobs found in Tampa, FL area

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Purveyor Relationship Manager
  • The Judge Group
  • Sarasota, FL
  • Hiring Company: Delicatessen Services Co., LLCOverview:The Purveyor Relationship Team is a department that helps maintai...
  • 3/28/2024 12:00:00 AM

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Customer Relationship Manager
  • Vitality Investments
  • Sarasota, FL
  • Job Description Job Description Chances Are This Career Opportunity Is Actually NOT For You... Unless, You Really Are a ...
  • 3/28/2024 12:00:00 AM

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Dealer Relationship Manager (Bilingual Spanish)
  • AFS Acceptance
  • Tampa, FL
  • POSITION SUMMARY We are one of the nation's top automobile loan providers and we are searching for ambitious, highly per...
  • 3/28/2024 12:00:00 AM

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Relationship Manager
  • Dynasty Financial Partners, LLC
  • Saint Petersburg, FL
  • Dynasty Financial Partners is seeking an individual to join the firm on the Relationship Management Team. The role of th...
  • 3/27/2024 12:00:00 AM

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Commercial Banking Relationship Manager
  • Valley Bank
  • Tampa, FL
  • Why you should consider applying to this opportunity: You're excited to build relationships with Commercial & Industrial...
  • 3/26/2024 12:00:00 AM

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Commercial Relationship Manager II
  • South State Bank
  • Zephyrhills, FL
  • As a leading regional bank, SouthState has been providing financial solutions to individuals, families, and businesses i...
  • 3/26/2024 12:00:00 AM

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Relationship Manager
  • Sabal Trust Company
  • Tampa, FL
  • Job Description Job Description Position: Trust & Financial Services Associate: Sabal Trust Company, Florida's largest e...
  • 3/24/2024 12:00:00 AM

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Relationship Manager - South
  • DOUBLELINE GROUP LP
  • Tampa, FL
  • Job Details Level Experienced Job Location Tampa, FL - Tampa, FL Position Type Full Time Description The Relationship Ma...
  • 3/24/2024 12:00:00 AM

Tampa is a major city in, and the county seat of, Hillsborough County, Florida, United States. It is on the west coast of Florida on Tampa Bay, near the Gulf of Mexico, and is the largest city in the Tampa Bay Area. The bay's port is the largest in the state, near downtown's Channel District. Bayshore Boulevard runs along the bay, and is east of the historic Hyde Park neighborhood. Today, Tampa is part of the metropolitan area most commonly referred to as the "Tampa Bay Area". For U.S. Census purposes, Tampa is part of the Tampa-St. Petersburg-Clearwater, Florida Metropolitan Statistical Area....
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Provider Relations Manager jobs
$95,795 to $138,191
Tampa, Florida area prices
were up 1.1% from a year ago

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