Provider Programs Manager jobs in Grand Rapids, MI

Provider Programs Manager oversees the provider network administration function of an organization. Collects data, analyzes and reports on claims, utilization, costs and changes. Being a Provider Programs Manager reviews existing and future reimbursement policies, regulations and guidelines. Ensure competitiveness of provider network by the deployment of cost effective programs and systems that deliver results that meet cost control and quality goals of the organization. Additionally, Provider Programs Manager requires a bachelor's degree. Typically reports to a manager or head of a unit/department. The Provider Programs 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 Programs 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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Senior Provider Programs Specialist Diabetes
  • Corewell Health
  • Grand Rapids, MI FULL_TIME
  • The Sr. Provider Specialist in this role must be Certified Diabetes Care and Education Specialist (CDCES) . This role provides expert diabetes care, management, and education for Priority Health. An ideal candidate will have knowledge of healthcare plans. They will also be detail oriented, self-motivated and have

    Microsoft Office experience.

    Under general direction, is a liaison for health plan initiatives with physician hospital organizations (PHO), physician organizations (PO) state-wide and community entities. Partners with internal teams to develop and implement strategic initiatives. Manages and coordinates large multi-faceted projects in an organized and cost effective manner.

    Essential Functions

    • Partner with internal teams and/or serve as a network/community liaison for strategic initiatives, training and Programs. This may include the assessment, analysis, planning, implementation and evaluation of multiple interventions, programs and data in support of Network efficiency, health outcomes and patient experience.
    • Identifies, monitors, coordinates and manages multiple projects. This includes project scope, targets, timelines, resource requirements/costs, milestones and data requirements. Creates and prepares accompanying documents and reports.
    • Coordinates the implementation of clinical pilots to ensure practice commitment to program goals and deadlines. Monitors results of pilot programs to ensure objective are achieved.
    • Responsible for the analysis, review and dissemination of network performance information, including but not limited to financial, quality, utilization/satisfaction and/or disease specific.
    • Develops and delivers or facilitates effective multi-media communication strategies, meetings, trainings and education materials for presentations with a variety of internal and external audiences.
    • Serves as subject matter expert and resource for researching industry practices, sharing best practice and market surveillance information to internal and external customers.
    • Certified Diabetes Care and Education Specialist (CDCES)

    Qualifications

    • Required Bachelor's Degree
    • Preferred Master's Degree
    • 5 years of relevant experience in health plan, managed care or healthcare delivery, administration or clinical practice management. Required
    • Knowledge of Facets Cactus, Health Information Technology and Business Objects. Preferred
    • Knowledge of Health and Population Technology and Provider reporting. Preferred
    • Certified Diabetes Care and Education certification required
    • Proficient with Microsoft Office, PowerPoint and Excel
    • GuidingCare software experience preferred
    • RN License preferred

      Physical Demands

      • Pallet to Waist (6" from floor) > 5 lbs: Seldom up to 10 lbs
      • Waist to Waist > 5 lbs: Seldom up to 10 lbs
      • Waist to Chest (below shoulder) > 5 lbs: Seldom up to 10 lbs
      • Waist to Overhead > 5 lbs: Seldom up to 10 lbs
      • Bilateral Carry > 5 lbs: Seldom up to 10 lbs
      • Unilateral Carry > 5 lbs: Seldom up to 10 lbs
      • Pushing Force > 5 lbs: Seldom up to 10 lbs
      • Pulling Force > 5 lbs: Seldom up to 10 lbs
      • Sitting: Frequently
      • Standing: Occasionally
      • Walking: Occasionally
      • Forward Bend - Standing: Seldom
      • Forward Bend - Sitting: Occasionally
      • Trunk Rotation - Standing: Seldom
      • Trunk Rotation - Sitting: Occasionally
      • Reach - Above Shoulder: Seldom
      • Reach - at Shoulder or Below: Seldom
      • Handling: Occasionally
      • Forceful Grip > 5 lbs: Seldom
      • Forceful Pinch > 2 lbs: Seldom
      • Finger/Hand Dexterity: Frequently

      Primary Location

      SITE - Priority Health - 1231 E Beltline - Grand Rapids

      Department Name

      PH - Care Management - Commercial

      Employment Type

      Full time

      Shift

      Day (United States of America)

      Weekly Scheduled Hours

      40

      Hours of Work

      8 a.m. to 5 p.m.

      Days Worked

      Monday to Friday

      Weekend Frequency

      N/A

      CURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.

      Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

      Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

      An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

      You may request assistance in completing the application process by calling 616.486.7447.

    • 1 Month Ago

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    Clinical Manager - Community Based Recovery Programs
    • Cherry Health
    • Grand Rapids, MI FULL_TIME
    • The Clinical Manager is responsible for providing overall direction and management for the operational and clinical activities of the Community Based Recovery Programs, Family Engagement Therapy (FET)...
    • 24 Days Ago

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    Advance Practice Practitioner - Palliative Care - Greater Grand Rapids
    • LTC Provider Care
    • Grandville, MI FULL_TIME
    • LTC Physician Care is a new and emerging medical group dedicated to serving patients across the care continuum focusing specifically on Skilled Nursing and Long-Term Care facility settings, to improve...
    • 1 Month Ago

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    Advanced Practice Practitioner
    • LTC Provider Care
    • Big Rapids, MI FULL_TIME
    • LTC Physician Care is a new and emerging medical group dedicated to serving patients across the care continuum focusing specifically on Skilled Nursing and Long-Term Care facility settings, to improve...
    • 1 Month Ago

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    Advanced Practice Practitioner - SNF/LTC
    • LTC Provider Care
    • Greenville, MI FULL_TIME
    • LTC Physician Care is a new and emerging medical group dedicated to serving patients across the care continuum focusing specifically on Skilled Nursing and Long-Term Care facility settings, to improve...
    • 1 Month Ago

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    Advanced Practice Practitioner - SNF/LTC
    • LTC Provider Care
    • Belding, MI FULL_TIME
    • LTC Physician Care is a new and emerging medical group dedicated to serving patients across the care continuum focusing specifically on Skilled Nursing and Long-Term Care facility settings, to improve...
    • 1 Month Ago

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    0 Provider Programs Manager jobs found in Grand Rapids, MI area

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    Program Supervisor, Home Study/Post Release Services
    • Catholic Charities West Michigan
    • Grand Rapids, MI
    • Position Summary: The Home Study/Post Release Services Program Supervisor is primarily responsible for overseeing case s...
    • 4/24/2024 12:00:00 AM

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    Management Trainee
    • Enterprise Holdings
    • Grand Rapids, MI
    • Overview: Start your career with Enterprise Mobility! Were hiring immediately for our respected Management Training Prog...
    • 4/23/2024 12:00:00 AM

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    Senior Manager, Technical Program Management (Card Data Tech)
    • Capital One
    • Grand Rapids, MI
    • West Creek 1 (12071), United States of America, Richmond, Virginia Senior Manager, Technical Program Management (Card Da...
    • 4/22/2024 12:00:00 AM

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    Sr. Director, Technical Program Management - Card Modernization
    • Capital One
    • Grand Rapids, MI
    • Center 1 (19052), United States of America, McLean, Virginia Sr. Director, Technical Program Management - Card Moderniza...
    • 4/22/2024 12:00:00 AM

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    Director, Technical Program Management - Card Data Tech
    • Capital One
    • Grand Rapids, MI
    • Center 1 (19052), United States of America, McLean, Virginia Director, Technical Program Management - Card Data Tech Abo...
    • 4/22/2024 12:00:00 AM

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    School Building Leader (Hiring at Multiple Levels)
    • GetSelected.com
    • Grand Rapids, MI
    • Free job-searching + PD for educators. Find a school you love! Position Description School Building Leadership at multip...
    • 4/22/2024 12:00:00 AM

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    Supervisor, Sterile Processing - Travel Nationwide
    • Steris Corporation
    • Grand Rapids, MI
    • At STERIS, we help our Customers create a healthier and safer world by providing innovative healthcare and life science ...
    • 4/21/2024 12:00:00 AM

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    Management Trainee – Non Exempt-DIV
    • Consolidated Electrical Distributors
    • Grand Rapids, MI
    • Summary Job title: Management Trainee Non Exempt-DIV Job ID: 202427000002 Department: Grand Rapids - APE Location: MI-Gr...
    • 4/20/2024 12:00:00 AM

    Grand Rapids is the second-largest city in Michigan, and the largest city in West Michigan. It is on the Grand River about 30 miles (48 km) east of Lake Michigan. As of the 2010 census, the city population was 188,040. In 2010, the Grand Rapids metropolitan area had a population of 1,005,648, and the combined statistical area of Grand Rapids-Muskegon-Holland had a population of 1,321,557. Grand Rapids is the county seat of Kent County. A historic furniture-manufacturing center, Grand Rapids is home to five of the world's leading office furniture companies, and is nicknamed Furniture City. Its ...
    Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
    Income Estimation for Provider Programs Manager jobs
    $103,277 to $133,405
    Grand Rapids, Michigan area prices
    were up 1.3% from a year ago

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