Managed Care Provider Relations Manager jobs in Minnesota

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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MSHO Managed Care RN Manager
  • University of MN Physicians
  • Minneapolis, MN FULL_TIME
  • University of Minnesota Physicians (M Physicians) is a non-profit organization seeking driven individuals in both clinical and non-clinical areas to help transform health and medicine. Headquartered in Minneapolis, our organization employs more than 1,200 physicians, 300 advanced practice providers and 2,200 health professionals and staff throughout Minnesota and beyond. Join us on a mission to advance medicine. Why M Physicians? Regardless of role, we recognize that every member of our team is vital! The MSHO Managed Care Manager manages the MSHO Program and oversees the managed care providers and staff, ensuring that all staff remain compliant with policies and mandates, and ensures proper communication of MSHO program. Leads and provides geriatric case management and coordination of care for defined enrollees within designated managed care organizations. MSHO Managed Care Manager, RN - Overview Key responsibilities include but are not limited to: Manages and operates MSHO program strategically for the growth and success of the program, employees and system partners. Utilizes knowledge of metro market, healthcare systems, trends and potential or actual changes that may affect program. Ensures program operates within Medicare, Medical Assistance and Federal Waiver programs rules and guidelines. Responsible for oversight of growth in enrollment numbers within each contract plan. Provides supervision and direction to MSHO staff. Manages staff expenses to budget FTE expense. Responsible for adaptation of staff and compliance process related to specialty programs within established contracts i.e. Stars Measures, medication management etc. Responsible for all MCO, DHS, CMS, HEDIS, TOC audits and audit outcomes. Continually assesses and improves the performance of care and services provided by the MSHO dept. Develops and maintains Policies and Procedures for program. Maintains positive relationships with health plans and providers. Participates with community partners (MCO, DHS) in trainings, certifications, and value enhancement measures for successful outcomes. Acts as resource/liaison to clinic staff, clients, payor companies and government agencies regarding administration of contract provisions and regulations. Manages or tracks case management data to show performance in product measures. Work with contracting department and finance to negotiate contract terms and appropriate reimbursement rates, review for accuracy of payments and develop utilization goals. Participates in Quality Management projects and PIP’s with UMP, DHS, MCO’s. Is available to give clinical supervision and direction to staff on a day to day basis. May carry small caseload to remain current with time management and work demands of care managers following all the mandates, criteria and requirements of the MSHO Care Manager position Minimum Qualifications: Licensed RN in Minnesota. BLS. BSN. 7 years of nursing experience 3 years of Home Care or Case Management experience with extensive knowledge of Home and Community Based Services 1-2 years of geriatric case management Supervisory experience Home internet for laptop Transportation for home visits Location: Remote with expectation to drive for home visits Hours: Full Time Benefits: This is a fully benefit eligible position: Competitive wages, Healthcare (including vision & dental), 401K, parking & tuition assistance and more! M Physicians offers competitive salary and excellent benefits and provides you with the opportunity to enhance your career in the exciting field of health care through rewarding and challenging assignments and the opportunities for advancement. We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, sex, gender, gender expression, sexual orientation, age, marital status, veteran status, or disability status. We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Company Overview: At University of Minnesota Physicians (M Physicians), we are on a mission to deliver exceptional patient care, advance medicine through research, and train the next generation of health professionals. M Physicians is the multi-specialty group practice for the University of Minnesota Medical School faculty clinicians, community-practice clinicians, advanced practice providers, and healthcare professionals. We serve the land grant mission of the University by providing high quality specialty and primary care, innovative and leading-edge cures and treatments, and access to the latest evidence-based care to patients across the state of Minnesota and beyond. Employment Update: As an organization deeply rooted in our community, it’s our responsibility to protect the wellbeing of our teams, provide a safe and healthy environment for those we serve, and to set an example for our neighbors. We take our obligation to care for our patients seriously. That is why M Physicians is requiring all employees, providers, learners and volunteers to receive an annual Flu vaccination unless a reasonable accommodation or exemption is granted. Application Instructions: External Candidates: Click “Apply” and sign in with your account. If you are a new applicant, select “Create Account”. Employees: If you are a current University of Minnesota Physicians employee, please log into Workday to access our Internal Careers Site. Contingent Workers: If you are not an employee but have an active Workday account with the University of Minnesota Physicians, please log into Workday and apply using the Find UMP Jobs Worklet.
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Medical Care Coordinator
  • Compass Medical Provider, LLC
  • Cottage Grove, MN CONTRACTOR,FULL_TIME
  • Compass Medical Provider is looking for a Medical Care Coordinator to support the Minnesota Army National Guard. Position Summary: Care Coordinator personnel will be responsible for coordinating and m...
  • 22 Days Ago

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Managed Care Contract Manager - Human Services Program Representative 2
  • State of Minnesota
  • Saint Paul, MN FULL_TIME
  • When all employees are embraced, respected and heard, we will build a collaborative, equitable, inclusive and anti-racist culture where everyone thrives. Job Details Working Title: Managed Care Contra...
  • 1 Day Ago

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Dir, Managed Care
  • Minnesota Oncology
  • Saint Paul, MN FULL_TIME
  • Overview: MINNESOTA ONCOLOGY Minnesota Oncology offers its employees an exciting, fast-paced, and challenging work environment. We are currently looking for a registered nurse with passion for the hea...
  • 12 Days Ago

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Healthcare Director - Managed Care
  • Minnesota Oncology
  • Cottage Grove, MN FULL_TIME
  • Overview: MINNESOTA ONCOLOGY Minnesota Oncology offers its employees an exciting, fast-paced, and challenging work environment. We are currently looking for a registered nurse with passion for the hea...
  • 1 Month Ago

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Director - Managed Care
  • Minnesota Oncology
  • Cottage Grove, MN FULL_TIME
  • Overview: MINNESOTA ONCOLOGY Minnesota Oncology offers its employees an exciting, fast-paced, and challenging work environment. We are currently looking for a registered nurse with passion for the hea...
  • 1 Month Ago

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Relationship Manager
  • Selby Jennings
  • New York, NY
  • My client is a an innovative FinTech firm that has been around for 20+ years specializing in helping clients with advanc...
  • 4/25/2024 12:00:00 AM

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Relationship Manager
  • Trove Family Office
  • Boston, MA
  • Company Overview Trove is an administrative financial services company that understands the complex needs of highnet-wor...
  • 4/24/2024 12:00:00 AM

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Relationship Manager
  • Alfred University
  • Alfred, NY
  • The University of Advancement is looking to fill two positions as the Relationship Manager. The Relationship Manager is ...
  • 4/24/2024 12:00:00 AM

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Relationship Manager
  • TCS Equipment Finance
  • Draper, UT
  • TCS Relationship Manager – Job Description TCS Equipment Finance is a leading private equipment financing company in the...
  • 4/23/2024 12:00:00 AM

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Relationship Manager
  • MAX Surgical Specialty Management
  • New Brunswick, NJ
  • We are seeking a motivated and dynamic individual to join our marketing team as a Relationship Manager. The ideal candid...
  • 4/23/2024 12:00:00 AM

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Relationship Manager
  • The Alliance Corporate Office
  • Burlington, NC
  • Job Description Job Description We are looking for an outgoing relationship manager to foster strong relationships with ...
  • 4/23/2024 12:00:00 AM

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Relationship Manager
  • Insight Global
  • Oakdale, MN
  • Title: Relationship Manager Location: Oakdale, MN Salary: ~$51k w/Quarterly Bonuses Targeting $12k per year Requirements...
  • 4/22/2024 12:00:00 AM

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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...
  • 4/22/2024 12:00:00 AM

Minnesota (/ˌmɪnɪˈsoʊtə/ (listen)) is a state in the Upper Midwest and northern regions of the United States. Minnesota was admitted as the 32nd U.S. state on May 11, 1858, created from the eastern half of the Minnesota Territory. The state has a large number of lakes, and is known by the slogan the "Land of 10,000 Lakes". Its official motto is L'Étoile du Nord (French: Star of the North). Minnesota is the 12th largest in area and the 22nd most populous of the U.S. states; nearly 60% of its residents live in the Minneapolis–Saint Paul metropolitan area (known as the "Twin Cities"). This area i...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Provider Relations Manager jobs
$103,218 to $148,894

Managed Care Provider Relations Manager in Trenton, NJ
Rizk says McKesson has created a collegial relationship by reaching out to providers.
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Managed Care Provider Relations Manager in Gary, IN
Aetna (57% favorable/37% unfavorable) has turned around providers by changing leadership and addressing provider concerns.
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Managed Care Provider Relations Manager in Birmingham, AL
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