Provider Contracting Manager jobs in Costa Mesa, CA

Provider Contracting Manager manages the activities of the contracting staff that prepare and maintain contracts and the contracts database system for a health plan network. Responsible for negotiating with facilities joining the health network and setting rates. Being a Provider Contracting Manager oversees network reporting requirements to ensure compliance with regulatory agencies, and to produce accurate and relevant reporting of data. Trains and develops staff. Additionally, Provider Contracting Manager requires a bachelor's degree. Typically reports to a head of a unit/department. The Provider Contracting 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 Provider Contracting 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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Behavioral Health Utilization Manager
  • HERITAGE PROVIDER NETWORK
  • Orange, CA FULL_TIME
  • JOB SUMMARY:

                                                                                                                                                                                      

    The BH Case Manager manages, creates and fosters comprehensive behavioral health and chemical dependency, utilization/case management through a series of activities that comply with all applicable regulations and statutes in adherence with the PBHC Compliance Framework.

     

    1. ROUTINE:
    1. Know and follow Employee Handbook policies and procedures.
    2. Have excellent written and verbal skills.
    3. Maintain patient/employee confidentiality.
    4. Actively contribute to all staff meetings.
    5. Follow dress code.
    6. Notify supervisor in writing when requesting time off.
    7. Be courteous and demonstrate customer service skills.
    8. Be flexible and adaptable to any situation or duty.
    9. Promote departmental and organizational goals.
    10. Know and follow applicable safety standards.

     

    1. ESSENTIAL JOB FUNCTIONS:

     

    Work Position:

    1. Sitting - Frequency - 70% or more.
    2. Standing - Frequency - less than 25%.
    3. Walking - Frequency - less than 25%.
    4. Driving – Frequency – 25% or more
    5. Travel – Frequency – 10% or more

     

    Body Movements:

    1. Lifting - 0-20 lbs; books, reams of paper, files, etc. - Frequency - approximately 20%.
    2. Bending, stooping and squatting - Frequency - approximately 15%.
    3. Reaching above head to 75 degrees - Frequency - approximately 15%.
    4. Hand/grip dexterity - Frequency - approximately 50%.

     

    1. SPECIFICS: (100% of time is dedicated to PBHC) 
    1. Identifies patients meeting Chemical Dependency and/or Behavioral Health criteria to be placed in the Behavioral Health and/or Chemical Dependency case management program under the behavioral health management system through Utilization Review meetings, Primary Care Physicians/Provider notification, medical case management referral, risk stratification, medical records review, and data analysis.
    2. Complete triage assessments to determine appropriate program referral. Refer patients to appropriate providers and programs including but not limited to PHP/IOP.
    3. Utilization Management and/or collaboration of inpatient admissions
    4. Intensive case management of chemically dependent and SPMI (Seriously and Persistently Mentally Ill) population.
    5. Complete care authorizations as necessary
    6. Work with physician providers and ancillary personnel to establish the appropriate monitoring schedule needed for patients in the program.
    7. Management/monitoring of Behavioral Health/Chemical Dependency patients to include daily/weekly/monthly phone calls as per established criteria, post-hospital follow-up/discharge phone call and direct contact in clinics/hospital/skilled nursing facility/home.
    8. Communicate with the primary care physician and nursing staff to assure appointments are being kept and the overall treatment plan is being adhered to.
    9. Communicate with member, members’ family and caregivers to ensure appointments are being kept, medications are being filled and taken, and the overall treatment plan is being adhered to.
    10. Maintain a collaborative relation with the medical group and health plan staff to ensure patient education, referrals for appropriate trainings and other avenues/efforts to assist in patient compliance.
    11. Works as liaison between in-patient and outpatient delivery systems to ensure continuity of care.
    12. Maintain computerized tracking systems and databases.
    13. Generate various reports to constituents as appropriate.
    14. Compile statistics and generate various reports to constituents as requested
    15. Actively participate in Interdisciplinary Care Team meetings by presenting appropriate Chemical Dependency and Behavioral Health cases for discussion and contribute at meetings to promote total case management.
    16. Assist department supervisor/case managers as directed.
    17. Assist with reviews and updates on quality, utilization, and member management policies and procedures.
    18. Other duties as assigned.

    The pay range for this position at commencement of employment is expected to be between $29.00/hour to $38.00/hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

    The total compensation package for this position may also include other elements, including a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

  • 1 Day Ago

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Inpatient LVN Case Manager
  • HERITAGE PROVIDER NETWORK, INC.
  • Orange, CA FULL_TIME
  • Position Summary: The Inpatient Case Manager is responsible for the assessment, treatment planning, intervention, monitoring, evaluation and documentation on identified patients during an acute care e...
  • 9 Days Ago

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Family Medicine Physician
  • Provider Solutions & Development
  • Aliso Viejo, CA FULL_TIME
  • South Coast Medical Group is seeking a full-time Family Medicine physician to join a well-established practice in southern California. You will be part of a dedicated, collaborative and team-oriented ...
  • Just Posted

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Family Medicine Physician
  • Provider Solutions & Development
  • San Clemente, CA FULL_TIME
  • Providence Mission Heritage Medical Group is seeking a full-time, board-eligible/board-certified Family Medicine physician to be a part of a growing organization in San Clemente, California. Work alon...
  • 2 Days Ago

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Credentialing & Contracting Coordinator
  • Matics Medical Office Services
  • Orange, CA FULL_TIME
  • Matics Medical Office Services provides comprehensive billing services for behavioral health practices across the United States, including psychotherapy, psychiatry, ABA, and chemical health. Our goal...
  • 1 Day Ago

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Associate Director, Pricing & Contracting
  • Welcome to the Tarsanet Internal Career Center!
  • Irvine, CA FULL_TIME
  • Let’s talk about some of the key responsibilities of the role: Associate Director, Pricing and Contracting. The individual in this role will manage of all the Market Access agreements including, but n...
  • 1 Month Ago

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0 Provider Contracting Manager jobs found in Costa Mesa, CA area

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Contracts Management Specialist (TS/SCI Required)
  • Millennium Space Systems, A Boeing Company
  • El Segundo, CA
  • Company Overview Millennium Space Systems, A Boeing Company delivers affordable, high-performance space systems for exac...
  • 3/28/2024 12:00:00 AM

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Purchasing Manager
  • Irving Knight Group
  • Santa Clarita, CA
  • Title: Purchasing Manager– Homebuilding Office Based: Santa Clarita, California Package: $125,000 - $175,000 + Bonus Res...
  • 3/28/2024 12:00:00 AM

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Procurement & Risk Manager
  • Moulton Niguel Water District, CA
  • Laguna Hills, CA
  • Salary: $136,156.80 - $183,248.00 Annually Location : Moulton Niguel Water District, CA Job Type: Full-Time Job Number: ...
  • 3/28/2024 12:00:00 AM

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CHE Managed Care Contract Manager
  • College Health Enterprises, Inc.
  • Santa Fe Springs, CA
  • Job Description Job Description Primary Duties and Responsibilities You will develop and negotiate hospital and professi...
  • 3/27/2024 12:00:00 AM

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Assistant Manager Contact Center
  • Shield HealthCare
  • Valencia, CA
  • Job Description Job Description Since 1957, Shield Healthcare has provided high-quality healthcare services while focusi...
  • 3/27/2024 12:00:00 AM

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Global Trade Compliance Manager - Contract to Hire - BB6109-1
  • TechData Service Company LLC
  • Santa Ana, CA
  • Job Description Job Description Global Trade Compliance Manager – Contract to Hire – BB6109-1 BB6109-1 Santa Ana, CA 18+...
  • 3/26/2024 12:00:00 AM

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Mental Health Contracts Manager
  • Stars Behavioral Health Group
  • Long Beach, CA
  • Partner with us in making a positive change! Join a community that's changing mental healthcare for the better. We have ...
  • 3/26/2024 12:00:00 AM

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Project Management Intern
  • Penhall Company Inc.
  • Anaheim, CA
  • Main Purpose: Provide overall on-site administrative and technical management on construction project site. This positio...
  • 3/25/2024 12:00:00 AM

Costa Mesa (/ˌkoʊstə ˈmeɪsə/) is a city in Orange County, California. Since its incorporation in 1953, the city has grown from a semi-rural farming community of 16,840 to a primarily suburban and edge city with an economy based on retail, commerce, and light manufacturing. The population was 109,960 at the 2010 United States Census. Costa Mesa is located 37 miles (60 km) southeast of Los Angeles, California, 88 miles (142 km) north of San Diego, California and 425 miles (684 km) south of San Francisco, Costa Mesa encompasses a total of 16 square miles (41 km2) with its southernmost border only...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Contracting Manager jobs
$121,465 to $161,305
Costa Mesa, California area prices
were up 3.0% from a year ago

Provider Contracting Manager in Scranton, PA
In order to properly oversee provider contracts, insurance companies must ensure all the medical professionals they are contracting with are properly credentialed; maintain detailed price sheets to standardize how much they are paying for services; and keep historical records of each account.
December 11, 2019
Provider Contracting Manager in Allentown, PA
The complete report provides the full listing of all companies nominated, as well as benchmark ratings for a listing of 40+ companies in account support and contracting.
January 16, 2020
Provider Contracting Manager in Savannah, GA
The Senior Provider Contract Manager is responsible for developing, negotiating, managing and leading complex contractual, legal and financial arrangements with providers that ensure CCA members have superior access to the highest quality, cost-effective providers of healthcare services.
January 03, 2020