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)
POSITION PURPOSE:
Responsible for the day-to-day delivery of individual support program services to assigned case load in accordance with Federal, State, and facility codes, regulations, guidelines and expectations.
ESSENTIAL FUNCTIONS OF POSITION:
EDUCATION / REQUIREMENTS:
Is one of the following: A doctor of medicine osteopathy, a registered nurse, an individual who holds at least a bachelor’s degree in a professional category specified in the Federal regulation 483.430 paragraph (b)(5) or designated as a human services professional that has at least a bachelor’s degree in a human services field (including, but not limited to: sociology, special education, rehabilitation counseling, and psychology).
At least one year’s experience working with intellectual disabilities or other developmental disabilities.
When State licensure and/or certification is required for the professional degree held by the QIDP, the license must be current and unencumbered.
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