Managed Care Provider Relations Manager jobs in Boise, ID

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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Provider Relations Network Manager- Idaho
  • Mount Carmel Health System
  • Boise, ID FULL_TIME
  • Employment Type:
    Full time
    Shift:

    Description:

    The Provider Relations & Network Manager is responsible for a full range of provider relations and service interactions in MediGold's Idaho market, including: contracting and recruitment, issue resolution and escalations, strategy development and execution, education, and retaining MediGold Contracted Providers. This position serves as the primary point of contact for the Providers and will require extensive relationship building, driving the resolution of complex issues, and MediGold brand building. The individual will also assist the Director for Provider Contracting and Network Development to develop provider collaborations that ensure network growth and quality/efficiency targets.

    Responsibilities

    • Recruit providers to build a cost effective and high quality provider network within MediGold guidelines.
    • Serve as the MediGold point of contact within the Provider network; Act as the MediGold Subject Matter Expert and brand ambassador.
    • Addresses customer complaints by directly handling the issue, working with the correct department(s) to resolve, or escalating as required.
    • Engage Providers to develop, coordinate, and lead training and distribution of materials.
    • Proactively drive communications with Providers via telephone/email and onsite visits.
    • Collaborates with the Director - Provider Contracting and Network Development to develop communication goals, strategies, and plans.
    • Negotiates provider contracts within MediGold guidelines and financial standards.
    • Collaborates with the Managers of Member and Provider Communications to oversee the completion of all provider communication content and materials.
    • Manages and works with other internal partners to facilitate provider Joint Operating Committee (JOC) Meetings.
    • Develops, implements, and manages policies, and procedures as assigned.
    • Assists Director and/or Sr. Director with the Medical Delivery Systems budget.
    • Manages successful implementation of provider contracts, including interpretation of payment and reimbursement terms.
    • Maintains excellent working relationships with MediGold's provider network, internal department management, other business partners, and Mount Carmel Health System related entities.
    • Exhibits a professional appearance and demeanor.
    • Travel to regional client locations and corporate office as required.
    • Use of personal vehicle for Provider visits required.
    • All other duties as assigned.

    Requirements

    • Education: Bachelor's degree in Healthcare Administration, Finance, related field or equivalent experience.
    • Experience: Minimum five years of experience with a Health Plan or Health Provider. Prior contracting and network development experience highly preferred
    • Knowledge of physician claims coding and Provider reimbursement payment methodologies; Ability to interpret Provider contracts
    • Willingness to be the point of contact for the MediGold brand within the Provider network
    • Establish and maintain relationships with Providers to ensure quality and satisfaction of services provided
    • Capacity to address complex problems including claims issues and customer service complaints; work with other departments to achieve resolution of the issues
    • Demonstrated ability to identify areas of opportunity within Provider networks for improving overall efficiency and quality
    • Working knowledge of protocols and procedures of Centers For Medicare and Medicaid Services
    • Proven ability to work effectively with internal and external multi-disciplinary teams across all levels of the organization
    • Proven track record of managing multiple priorities and executing tasks within tight timeframes
    • Experience in identifying and executing process improvement needs
    • Must possess a high degree of motivation, initiative, and organization ability
    • Valid driver's license

    Discovering opportunities, support and excellence – all while making a real difference in patients’ lives – begins at Mount Carmel. Find a new beginning and advance your career with us.

    Mount Carmel and all its affiliates are proud to be equal opportunity employers. We do not discriminate on the basis of race, gender, religion, physical disability or any other classification protected under local, state or federal law.

    Our Commitment to Diversity and Inclusion


    Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

  • 4 Days Ago

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Managed care
  • Pennant Group
  • Eagle, ID FULL_TIME
  • JOB SUMMARY The Managed Care Resource will support our Home Health, Hospice, Private Duty and Senior Living Facility leaders in managed care contracting and revenue enhancement strategies for all heal...
  • 15 Days Ago

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Care provider
  • Trailridge Family Dental
  • Parma, ID FULL_TIME
  • Do you want to provide platinum patient care to your patients? If so, then we are the team for you!!Trailridge Family Dental is a busy, growing dental practice located in Parma, ID. We are looking for...
  • 27 Days Ago

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Managed Services GTM Business Manager – Direct Sales
  • Hewlett Packard
  • Boise, ID FULL_TIME
  • Managed Services GTM Business Manager – Direct Sales Description HP’s vision is to create technology that makes life better for everyone, everywhere — every person, every organization, and every commu...
  • 1 Month Ago

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Community Relations Director - Assisted Living
  • Prestige Care, Inc
  • Caldwell, ID FULL_TIME
  • Salary Range $50,000 - $65,000 Monthly Commission! Position Details: Status: Fulltime Shift: Day Schedule: Various Working Hours Start: Various Working Hours End: Various What does the Community Relat...
  • 1 Day Ago

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Preventive Dental Care Provider
  • Trailridge Family Dental
  • Parma, ID FULL_TIME
  • Job Description Are you happy and fun? Are you a positive person? Do you value integrity and devotion? Do you enjoy creating value in others? Do you want to provide platinum patient care to your patie...
  • 22 Days Ago

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0 Managed Care Provider Relations Manager jobs found in Boise, ID area

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Relationship Manager
  • WaFd Bank
  • Boise, ID
  • Min: USD $85,000.00/Yr. Max: USD $130,000.00/Yr. Job Summary: A Relationship Manager is responsible for developing a bus...
  • 3/28/2024 12:00:00 AM

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Travel Nurse RN - Cardiac Cath Lab - $1,935 per week
  • PRN Healthcare
  • Boise, ID
  • Springboard Healthcare is seeking a travel nurse RN Cardiac Cath Lab for a travel nursing job in Boise, Idaho. Job Descr...
  • 3/28/2024 12:00:00 AM

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Government Relations Manager
  • PMI (Project Management Institute)
  • Boise, ID
  • Government Relations Manager United States * Virtual Req #463 Thursday, December 28, 2023 Want to help people learn the ...
  • 3/27/2024 12:00:00 AM

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Physician - Physician
  • Saint Alphonsus Regional Medical Center
  • Boise, ID
  • 5x8 Days, 08:00:00-16:00:00, 8.00-5 Saint Alphonsus is looking for a full timelocum Anesthesiologist to start May 2024. ...
  • 3/27/2024 12:00:00 AM

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Customer Service Representative
  • Tandem Diabetes Care Inc.
  • Boise, ID
  • ** Customer Service Representative** **Job Category****:** Technical Service **Requisition Number****:** CUSTO03959 Show...
  • 3/26/2024 12:00:00 AM

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Territory Manager - Coeur d'Alene, ID
  • US Foods, Inc.
  • Idaho, ID
  • ESSENTIAL DUTIES AND RESPONSIBILITIES • Foster the customer relationship in a team based selling model. • Manage deliver...
  • 3/24/2024 12:00:00 AM

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Senior Vice President, Relationship Manager
  • Idaho Trust Bank
  • Boise, ID
  • WHY WORK WITH US Idaho Trust Bank, headquartered in beautiful Boise, Idaho, is listed as one of America’s Best Business ...
  • 3/24/2024 12:00:00 AM

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Inside Sales Manager
  • Western Power Sports (WPS)
  • Boise, ID
  • As an Inside Sales Manager you will develop and deploy a sales strategy with a remote Inside Sales team and stakeholders...
  • 3/24/2024 12:00:00 AM

Boise (/ˈbɔɪsi/ (listen)) is the capital and most populous city of the U.S. state of Idaho, and is the county seat of Ada County. Located on the Boise River in southwestern Idaho, the population of Boise at the 2010 Census was 205,671, the 99th largest in the United States. Its estimated population in 2016 was 223,154. Boise is in southwestern Idaho, about 41 miles (66 km) east of the Oregon border, and 110 miles (177 km) north of the Nevada border. The downtown area's elevation is 2,704 feet (824 m) above sea level. Most of the metropolitan area lies on a broad, flat plain, descending to the ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Provider Relations Manager jobs
$93,728 to $135,210
Boise, Idaho area prices
were up 2.5% from a year ago

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