Provider Contracting Manager jobs in Pasadena, 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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Outpatient Renal Case Manager
  • HERITAGE PROVIDER NETWORK, INC.
  • Northridge, CA FULL_TIME
  •  We are looking for an Outpatient Renal Case Manager RN to join our team.

     

     

    The Outpatient Case Manager RN is responsible for the assessment, treatment planning, intervention, monitoring, evaluation and documentation on identified High Risk members.  The Outpatient Case Manager RN will assess and develop a care plan in collaboration with the admitting, attending and consulting physician, the member and other health care practitioners.   The goal of the Outpatient Case Manager RN is to effectively manage members on an outpatient basis to assure the appropriate level-of-care is provided, to prevent in patient admission and re-admissions, and ensure that the members’ medical, environmental, and psychosocial needs are met over the continuum of care. 

     

    Essential Duties and Responsibilities include the following:

    • Keeps member/family members or other customers informed and requests if necessary, further assistance when  needed.
    • Demonstrates the ability to follow through with requests, sharing of critical information, and getting back to individuals in a timely manner.
    • Functions as liaison between administration, members, physicians and other healthcare providers.
    • Interacts professionally with member/family/physicians and involves member/family/physicians in formation of the plan of care.
    • Performs a Clinical Assessment/Questionnaire of the member and determines an acuity score for necessary scheduled follow-up.
    • Develops an outcome-based plan of care, based on the member’s input and assessed member needs. Implements and evaluates the plan of care as often as needed as evidenced by documentation in the member’s case file.
    • Documents member assessment and reassessment, member care plans, and other pertinent information completed in the member’s medical record in accordance with the FOCUS Charting methodology, nursing standards, and company policies and procedures.
    • Initiates community visits (hospital, home visits) as needed to assess patient progress and meet with appropriate members of the patient care team.
    • Identifies planned and unplanned transitions of care from Requests for Services or daily inpatient and SNF census.
    • Educates the member/caregiver on the transition process and how to reduce unplanned transitions of care.
    • Manages transition of care from the sending to receiving settings ensuring that the Plan of Care moves with the member and updates/modifies the care plan as the member’s health care status changes.
    • Communicates appropriately and clearly with physicians, in patient case managers and Prior-Authorization nurses
    • Identifies and addresses psychosocial needs of the members and family and facilitates consultations with Social Worker, as necessary.
    • Identifies and addresses pharmacological needs of the members and facilitates consultations with the pharmacy department, as necessary.
    • Identifies community resources to address needs not covered by the member’s benefit plan, and coordinates member benefits as needed, with the health plan.
    • Participates in the efficient, effective and responsible use of resources such as medical supplies and equipment.
    • Responsible for the coordination and facilitation of member and family conferences as determined by assessment of member’s needs.
    • Identifies the appropriate members to participate in the interdisciplinary case round process. Prepares the necessary summary information to present to the team.
    • Responsible for the coordination of clinic appointments, medication reconciliation, PCP and SPC visits.
    • Ability to collaborate and communicate with all members of the healthcare team (concurrent review, pre-authorization, PCP/SPC, Social Services, and Pharmacy) to coordinate the continuum of care of developing plans for management of each case.
    • Responsible for the identifying members that are appropriate for hospice conversion or Palliative care.
    • Meet with members/caregiver face to face in different locations (clinic, home, hospital, and community) in order to build a rapport with member so that the case manager can better support member/caregiver with care coordination and the plan of care.
    • Other duties as assigned by management. 

     

    The pay range for this position at commencement of employment is expected to be between $45.00-$50.00/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 sign-on bonus and discretionary awards in addition to 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.

     

    Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

     

    If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

     

     

    As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

     

    Full Time Position Benefits:

    The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

    Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

     

    Health and Wellness:

    • Employer-paid comprehensive medical, pharmacy, and dental for employees
    • Vision insurance
    • Zero co-payments for employed physician office visits
    • Flexible Spending Account (FSA)
    • Employer-Paid Life Insurance
    • Employee Assistance Program (EAP)
    • Behavioral Health Services

    Savings and Retirement:

    • 401k Retirement Savings Plan
    • Income Protection Insurance

    Other Benefits:

    • Vacation Time
    • Company celebrations
    • Employee Assistance Program
    • Employee Referral Bonus
    • Tuition Reimbursement
    • License Renewal CEU Cost Reimbursement Program
    • Business-casual working environment
    • Sick days
    • Paid holidays
    • Mileage

     

    Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

     

  • Just Posted

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Project Manager, HCC
  • HERITAGE PROVIDER NETWORK, INC.
  • Northridge, CA FULL_TIME
  • Summary of position: The HCC Project Manager is responsible for coordination and supporting of all projects related to the Risk Adjustment program within the organization. Lead interaction with provid...
  • Just Posted

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Inpatient Case Manager LVN
  • HERITAGE PROVIDER NETWORK, INC.
  • Covina, 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...
  • Just Posted

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Inpatient Case Manager, AH Weekends
  • HERITAGE PROVIDER NETWORK, INC.
  • Northridge, CA FULL_TIME
  • We are looking for experienced Inpatient Case Managers, After Hours /Weekends to join our team. They will follow-up appointments in the authorization notes and will communicate the same to the Vital C...
  • Just Posted

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Inpatient Case Manager, AH Weekends
  • HERITAGE PROVIDER NETWORK, INC.
  • Northridge, CA FULL_TIME
  • We are looking for experienced Inpatient Case Managers, After Hours /Weekends to join our team. They will follow-up appointments in the authorization notes and will communicate the same to the Vital C...
  • 1 Day Ago

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Transfer Case Manager ( LVN or RN )
  • HERITAGE PROVIDER NETWORK, INC.
  • Northridge, CA FULL_TIME
  • Position Summary: The Inpatient Transfer Case Manager is responsible for the assessment, treatment planning, intervention, monitoring, evaluation and documentation on identified patients during an acu...
  • 7 Days Ago

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0 Provider Contracting Manager jobs found in Pasadena, 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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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

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Commissary Manager - San Bernardino Commissary
  • Aramark
  • Ontario, CA
  • Job Description As a Commissary Manager at the San Bernadino Commissary, you will direct the daily retail/commissary ope...
  • 3/19/2024 12:00:00 AM

Pasadena is a city in Los Angeles County, California, United States, located 10 miles (16 kilometers) northeast of Downtown Los Angeles. The estimated population of Pasadena was 142,647 in 2017, making it the 183rd-largest city in the United States. Pasadena is the ninth-largest city in Los Angeles County. Pasadena was incorporated on June 19, 1886, becoming one of the first cities to be incorporated in what is now Los Angeles County, following the city of Los Angeles (April 4, 1850). It is one of the primary cultural centers of the San Gabriel Valley. The city is known for hosting the annua...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Contracting Manager jobs
$122,304 to $162,419
Pasadena, California area prices
were up 3.2% 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