Managed Care Provider Relations Manager jobs in the United States

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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Recruitment & Credentialing Provider Relations Specialist
  • First Managed Care Option
  • Parsippany, NJ FULL_TIME
  • PRIMARY FUNCTION

    Responsible for the procedures associated with recruitment of Auto/Pip experienced providers into network, which includes receipt, review, and processing of credentialing application and to serve as liaison between the providers and FMCO. As such, responsible for recruitment, communication, and resolution of questions and issues between the provider and the Company.

    RESPONSIBILITIES

    Recruitment

    · Identify and communicate with potential providers via telephone and written correspondence.

    · Ensure provider experience and understanding of Auto/Pip

    · Attend meetings at providers’ offices relating to recruitment process.

    · Maintain and update electronic log of potential providers’ current status in recruitment process.

    · Ensure that all documentation is completed to facilitate a smooth credentialing process.

    · Provide weekly written report of all activities.

    Credentialing

    · Interact with potential providers.

    · Distribute, assist in completion and collect all credentialing materials.

    · Support and facilitate the credentialing process; inform the provider of credentialing status.

    · Data entry of provider information into Provider Database.

    · Prepare necessary reports for review of Quality Management Committee.

    · Assist in collecting information for appeals and sanctioning processes.

    Provider Relations

    · Identify and interact with potential providers and educate regarding FMCO policy and procedure.

    · Act as a liaison between the providers and FMCO.

    · Distribute and assist in completion of provider applications and contracts.

    · Conduct on-site visits to provider locations, as necessary.

    · Ensure that providers are adequately supplied with all necessary forms.

    · Maintain the Provider Database.

    · Assist in the resolution of provider issues.

    · Maintain the Provider QA Database.

    · Communicate with the Quality assurance supervisor, as necessary.

    · Prepare reports for the Quality Management Committee.

    · Assist in provider education program.

    · Attend in-services to update skills and information in changes in plans or procedures.

    EDUCATION, EXPERIENCE, SKILLS

    · Bachelors Degree preferred.

    · Previous experience in medical field desirous.

    · Previous experience with NJ PIP Fee Schedule and rules desirous.

    · Must exercise sound judgment, and possess ability to work with minimum supervision.

    · Excellent verbal and written communication skills.

    · Excellent negotiation skills.

    · Computer proficiency.

    · Ability to prioritize duties.

    First Managed Care Option, Inc., is an Equal Opportunity Employer and takes pride in maintaining a diverse environment. We do not discriminate in recruitment, hiring, training, promotion or any other employment practices for reasons of race, color, religion, gender, national origin, age, sexual orientation, marital or veteran status, disability, or any other legally protected status.

  • 2 Days Ago

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Provider Relations Manager
  • Buckeye Hospice and Palliative Care
  • Portage, OH FULL_TIME
  • **JOIN A TEAM, MAKE A DIFFERENCE!!** Buckeye Hospice and Palliative Care Services has expanded its reach across Ohio. This expansion presents a unique opportunity for a Provider Relations Manager to l...
  • 3 Days Ago

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Provider Relations Manager
  • Buckeye Hospice and Palliative Care
  • McConnelsville, OH FULL_TIME
  • **JOIN A TEAM, MAKE A DIFFERENCE!!** Buckeye Hospice and Palliative Care Services has expanded its reach across Ohio. This expansion presents a unique opportunity for a Provider Relations Manager to l...
  • 6 Days Ago

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Provider Relations Manager
  • Buckeye Hospice and Palliative Care
  • Geneva, OH FULL_TIME
  • **JOIN A TEAM, MAKE A DIFFERENCE!!** Buckeye Hospice and Palliative Care Services has expanded its reach across Ohio. This expansion presents a unique opportunity for a Provider Relations Manager to l...
  • 9 Days Ago

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Provider Relations Manager
  • Buckeye Hospice and Palliative Care
  • Mineral, OH FULL_TIME
  • **JOIN A TEAM, MAKE A DIFFERENCE!!** Buckeye Hospice and Palliative Care Services has expanded its reach across Ohio. This expansion presents a unique opportunity for a Provider Relations Manager to l...
  • 11 Days Ago

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Provider Relations Manager
  • Buckeye Hospice and Palliative Care
  • Boardman, OH FULL_TIME
  • **JOIN A TEAM, MAKE A DIFFERENCE!!** Buckeye Hospice and Palliative Care Services has expanded its reach across Ohio. This expansion presents a unique opportunity for a Provider Relations Manager to l...
  • 11 Days Ago

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Relationship Manager
  • TritonPoint Wealth
  • Chevy Chase, MD
  • Overview: TritonPoint Wealth, renowned for its entrepreneurial and independent spirit, seeks a Relationship Manager who ...
  • 3/28/2024 12:00:00 AM

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Client Relationship Manager
  • Obsidian Business Planning Solutions
  • Rockville, MD
  • Obsidian Planning Solutions, a financial planning firm located in Rockville, MD, is hiring a Senior Relationship Manager...
  • 3/27/2024 12:00:00 AM

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Customer Relationship Manager
  • Orion Management LLC.
  • Springfield, VA
  • **Customer Relationship Manager** Location **Springfield, VA** Job Code **113** # of Openings **1** Founded in 2001, Ori...
  • 3/27/2024 12:00:00 AM

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Cloud Business Relationship Manager
  • T-Rex Solutions
  • Washington, DC
  • Job Description Job Description T-Rex Solutions is looking to select a Business Relationship Manager to support the US D...
  • 3/27/2024 12:00:00 AM

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CRE Relationship Manager
  • Eagle Bancorp, Inc.
  • Bethesda, MD
  • Overview We are a values driven organization putting Relationships FIRST. EagleBank (NASDAQ - EGBN) is focused on being ...
  • 3/26/2024 12:00:00 AM

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GCB Sr. Relationship Manager
  • Bank of America Corporation
  • Mc Lean, VA
  • Job Description: At Bank of America, we are guided by a common purpose to help make financial lives better through the p...
  • 3/26/2024 12:00:00 AM

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Commercial Banking Relationship Manager
  • Hingham Institution for Savings
  • Washington, DC
  • Hingham's Specialized Deposit Group (SDG) is looking for a Relationship Manager to take responsibility for some of the B...
  • 3/25/2024 12:00:00 AM

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Senior Client Relationship Manager
  • LHH
  • Washington, DC
  • LHH is hiring on behalf of an esteemed client in the legal field. We are hiring for a Senior Client Relationship Manager...
  • 3/24/2024 12:00:00 AM

Income Estimation for Managed Care Provider Relations Manager jobs
$100,646 to $145,189