Managed Care Provider Relations Manager jobs in Ventura, CA

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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Provider Relations Rep
  • Dignity Health Management Services
  • OXNARD, CA FULL_TIME
  • Overview

    The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups hospitals health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options including medical dental and vision plans for the employee and their dependents Health Spending Account (HSA) Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.


    Responsibilities

    The Provider Relations Representative is responsible for establishing and maintaining positive relationships with various clients building strong, cohesive business partnerships. Works with internal staff, client representatives, and other contracted entities to deliver contractual performance standards and ensure customer service objectives are continually met.

     

    The Provider Relations Representative must have the ability to handle various situations in a professional manner, demonstrating excellent customer service at all times and ability to adapt to change. Must be able to work collaboratively with multiple internal departments as well as external organizations. Willingness to work as part of a team, working with others to
    achieve goals, solve problems, and meet established organizational objectives.

     

    Successful candidates will:

    • Have the ability to establish and maintain positive business relationships, negotiate favorably, collaborate with others, and build consensus both externally and
      internally to achieve desired results. Understand Summary Plan Descriptions, Benefit Summaries, internal operations workflows, and claims policies & procedures. 
    • Possess strong business acumen, customer service skills, follow-up, organizational and project management skills to ensure objectives and deadlines are consistently met.
    • The ability to establish and maintain positive business relationships, negotiate favorably, collaborate with others, and build
      consensus both externally and internally to achieve desired results.
    • Ability to understand and interpret regulatory concerns as applicable to the contract, including HIPAA privacy and security, CMS rules and regulations, and ERISA.
    • Ability to continually re-prioritize to meet the needs of internal and external customers throughout the workday. Thorough knowledge of generally accepted professional office procedures and processes.
    • Must be able to travel to locations both in and out of town which may require overnight stays on occasion.

     

     

    Please Note:  This position is physically located in Santa Cruz, CA and will support the local Santa Cruz market as a hybrid field support / remote work from home role. 75% of your time will be spent in the field interfacing with clients. While the other 25% may be spent in your home office.

     

     

     

     

     


    Qualifications

    Minimum Qualifications:

    • High School Diploma/GED - 5 or more years' experience working in a similar position in the healthcare industry; or an equivalent combination of training and experience that provide the capabilities needed to perform the job duties.
    • Experience in marketing, sales or customer service in a health care setting required. Strong business acumen, customer service skills, follow-up, organizational and project management skills to ensure objectives and deadlines are consistently met.
    • Familiarity with third party administrator operations such as eligibility, prior authorization, claims administration and provider network administration. Familiarity with managed care and selfinsurance products and benefits.
    • Prior experience demonstrating the ability to understand and interpret laws, rules and regulations as defined under state and Federal statutes along with remaining current on Healthcare Reform updates and changes.
    • Strong problem-solving abilities.
    • Ability to identify issues and problems within administrative processes activities, and other relevant areas.
    • Excellent communication skills; able to read, write, and speak articulately, using established channels of communication and reporting relationships within the organization. Ability to communicate effectively with all levels of internal/external staff, management, clients, physicians and physician office staff.
    • Ability to handle various situations in a professional manner, demonstrating excellent customer service at all times and ability to adapt to change.
    • Ability to create professional documents using proper grammar, punctuation and appropriate reading level proficient in the use of Microsoft Office applications; Excel, Word, Access, Outlook, PowerPoint, Project.

    Other Preferred Qualifications:

    • Experience working as an account manager in a direct to employer health plan preferred.
    • Associate's degree or equivalent from accredited college or technical school; or two or more years of account management experience working with a medical group or IPA in a managed care environment.

     

     

  • 17 Days Ago

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Care Provider (NOC)
  • Oakmont Senior Living
  • Oxnard, CA FULL_TIME
  • Position: Care Provider Night Shifts (NOC) Pay Range: $17.00 - $18.00 Oakmont of Riverpark is a premier senior living community situated on a beautifully landscaped campus. Managed by Oakmont Manageme...
  • 8 Days Ago

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Community Relations Manager
  • California Lutheran University
  • Thousand Oaks, CA FULL_TIME
  • Position Category: Staff (Exempt) FLSA: Exempt FTE: 1 Location: Thousand Oaks University Background: The mission of California Lutheran University is to educate leaders for a global society who are st...
  • 15 Days Ago

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Sales Manager/ Care Coordinator
  • Always Best Care - Thousand Oaks
  • Thousand Oaks, CA FULL_TIME
  • Sales Manager / Care Coordinator Always Best Care, a National home care company, is currently looking for a seasoned, energetic sales rock star that is experienced in closing, anticipating customer ne...
  • 17 Days Ago

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Primary Care Provider: Telehealth, Cardiovascular Risk Reduction. California: Ventura County - Simi Valley & Surrounding Areas
  • Movn Health
  • Simi Valley, CA PART_TIME
  • Background We are seeking a highly motivated and compassionate Primary Care Provider to join our dynamic team. The selected candidate will play a crucial role in delivering routine primary care and ch...
  • 26 Days Ago

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Dental Operations Manager
  • Dr. Zak Dental Care
  • Simi Valley, CA FULL_TIME
  • About us At Zak Dental we believe that our patients’ oral health needs are best served by our multi-specialty TEAM who stands behind the quality of care that we deliver. We refer to our dental care as...
  • 20 Days Ago

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0 Managed Care Provider Relations Manager jobs found in Ventura, CA area

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Client Relationship Manager
  • Ernest
  • Santa Barbara, CA
  • Ernest is currently in search of a Client Relationship Manager (outside B2B sales) within our Santa Barbara, CA territor...
  • 4/25/2024 12:00:00 AM

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TeleSales Representative - Remote
  • InsuraTec Services Group
  • Ventura, CA
  • TeleSales Representative- Remote Job Description: Are you a self-motivated, driven individual with a passion for sales a...
  • 4/25/2024 12:00:00 AM

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TeleSales Representative - Remote
  • InsuraTec Services Group
  • Oxnard, CA
  • TeleSales Representative- Remote Job Description: Are you a self-motivated, driven individual with a passion for sales a...
  • 4/25/2024 12:00:00 AM

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Sales Executive
  • City Lifestyle
  • Oxnard, CA
  • Join the City Lifestyle Team as a Sales Executive City Lifestyle, formerly known as Lifestyle Publications, has been a p...
  • 4/25/2024 12:00:00 AM

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Director, Customer Service
  • Western Growers
  • Oxnard, CA
  • **Description** Join our team of dedicated professionals who are committed to ensuring our clients can provide affordabl...
  • 4/25/2024 12:00:00 AM

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Senior Public Relations Manager
  • AppFolio, Inc.
  • Santa Barbara, CA
  • Description AppFolio is more than a company. We're a community of dreamers, big thinkers, problem solvers, active listen...
  • 4/23/2024 12:00:00 AM

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Out-Patient UM Clinician
  • MedPOINT Management
  • Thousand Oaks, CA
  • Job Description Job Description Summary Reporting to the Outpatient Lead Clinician, the Outpatient UM Clinician is respo...
  • 4/23/2024 12:00:00 AM

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Senior Relationship Manager
  • PayJunction
  • Santa Barbara, CA
  • We are seeking a Relationship Manager to manage PayJunction’s pipeline of ISV and Referral partnerships with day-to-day ...
  • 4/22/2024 12:00:00 AM

Ventura is located northwest of Los Angeles on the California coast. The western portion of the city stretches north along the Ventura River and is characterized by a narrow valley with steeply sloped areas along both sides. The steep slopes of the Ventura foothills abut the northern portion of the community. Much of the eastern portion is on a relatively flat alluvial coastal plain lying along the western edge of the Oxnard Plain. The Santa Clara River forms the city's southerly boundary with the city limits reaching up to the beginning of the Santa Clara River Valley at the historic communit...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Provider Relations Manager jobs
$108,162 to $156,026
Ventura, California area prices
were up 2.5% from a year ago

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