Managed Care Provider Relations Manager jobs in Caldwell, ID

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

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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.

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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.