Managed Care Provider Relations Manager jobs in Muskogee, OK

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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Pharmacy - Managed Care Clinical Pharmacist 146-2002
  • CommunityCare
  • Tulsa, OK FULL_TIME
  • JOB SUMMARY:
    The Managed Care Clinical Pharmacist will provide clinical pharmacy support to the CommunityCare Pharmacy Department including development of criteria for medications requiring a prior authorization, management of the drug utilization protocol, clinical support for the CMS Medication related STARs Measures, Medication Therapy Management (MTM) outreach, and other clinical duties as needed. The ability to influence members and providers to act is important. This position will also work closely with the Patient’s at Risk Committee, reviewing data to identify and investigate possible medication related fraud, waste, and abuse.

    KEY RESPONSIBILITIES:
    • Medication CMS Stars Measures – Provide support to the pharmacy and quality department for medication related Stars Measures. Analyze data, identify areas of opportunity, contact members to identify barriers.
    • Medication Therapy Management (MTM) – Support the Medication Therapy Management Program for qualifying members. Review MTM gaps and complete Comprehensive Medication Reviews with qualifying members to support the program.
    • P&T Committee Clinical Support - Work with Director of Pharmacy on development of clinical presentations and drug utilization review programs. Provide clinical input to administrative staff in the preparation of Committee minutes.
    • Clinical Liaison to PBM - Work with PBM as directed by the director of pharmacy to support clinical programs, identify areas to improve quality and reduce costs.
    • Formulary Development – Work with the Director of Pharmacy on formulary development and maintenance with P&T Committee and PBM to assure accuracy of adjudication files, CMS files, print and web formulary files.
    • Prior-Authorization Reviews – Review medication requests that require a prior authorization and approve or deny based upon established criteria or clinical data provided.
    • Internal/External Meetings - Provide clinical pharmacy input at various internal and external meetings, as necessary.
    • Perform other duties as assigned.
    QUALIFICATIONS:
    • Demonstrated understanding and application of managed care concepts and terminology.
    • Extensive experience in management of pharmacy clinical programs.
    • Proficient in Microsoft applications.
    • Successful completion of Health Care Sanctions background check.
    • Excellent analytical, organizational, and decision making skills.
    • Successful completion of Health Care Sanctions background check. (Is this the same as the line above?) Yes. I deleted the precious one. Possess strong oral and written communication skills.
    EDUCATION/EXPERIENCE:
    • Graduation from an accredited School of Pharmacy. PharmD preferred.
    • Current and active unrestricted license to practice pharmacy in the state of Oklahoma.
    • Minimum of 3 years work experience in a managed health care environment specific to pharmacy management activities preferred.
    • 5 years clinical pharmacy experience.
    • Managed care and long-term care pharmacy experience preferred.
    CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin
  • 8 Days Ago

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Customer Relations Specialist
  • Community Care College
  • Tulsa, OK FULL_TIME
  • Community College is seeking a professional to work the busy front desk as a part-time Customer Relations Specialist (CRS)! The CRS will be the first point of contact for the public, on the phone and ...
  • 9 Days Ago

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Employee Relations Manager
  • Tulsa Public Schools
  • Tulsa, OK OTHER
  • Full Job Description: Employee Relations ManagerSalary Grade: Business Grade 09/ BG-09 Tulsa Public Schools' existing salary schedules provide career increment adjustments based on education/experienc...
  • 7 Days Ago

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Advanced Practice Provider (NP/PA)
  • Xpress Wellness Urgent Care
  • Jenks, OK FULL_TIME
  • Xpress Wellness offers a great working environment in state-of-the art urgent care facilities with the following perks: Work-life balance with a Flexible schedule Competitive base salary Productivity ...
  • 25 Days Ago

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Family/Internal Medicine Physician | Flexible Employment Opportunity | Freedom from Managed Care System
  • Spectrum Healthcare Resources
  • Claremore, OK FULL_TIME
  • Join Spectrum Healthcare Resources, a trusted industry leader for over 35 years, and make a change in your career with the military medical system. Enjoy freedom from the traditional pressures of the ...
  • 20 Days Ago

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Field Provider Manager
  • Lowe's
  • Tulsa, OK FULL_TIME
  • Lowe’s is able to offer remote employment of this position in the following states: AL, AR, AZ, CA(salaried roles only), CT, CO, DE, FL, GA, IA, ID, IL, IN, KS, KY, LA, MD, MA, ME, MI, MN, MO, MS, MT,...
  • 20 Days Ago

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0 Managed Care Provider Relations Manager jobs found in Muskogee, OK area

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Business Development Manager (Sales)
  • RestoPros of Tulsa
  • Tulsa, OK
  • Job Description Job Description We are seeking a highly motivated and energetic Business Development Manager to join our...
  • 3/29/2024 12:00:00 AM

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Senior Grant Writer
  • Write On Fundraising
  • Tulsa, OK
  • Job Description Job Description Senior Grant Writer Job Description Write On Fundraising brings equity and compassion to...
  • 3/29/2024 12:00:00 AM

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Territory Manager - Oklahoma City / Tulsa
  • Accordance Search Group
  • Tulsa, OK
  • Position Overview The Territory Manager is responsible for partnering with key stakeholders across multiple departments ...
  • 3/28/2024 12:00:00 AM

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Financial Advisor
  • New York Life Tulsa
  • Tulsa, OK
  • Are you a leader who has the following traits? Competitive Ambitious Coachable Communicative Self-disciplined Authentic ...
  • 3/28/2024 12:00:00 AM

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Small to Medium Business Account Executive
  • Optimum
  • Muskogee, OK
  • Are you looking to Optimize your life? Start your exciting path to a rewarding career today! We are Optimum, a leader in...
  • 3/27/2024 12:00:00 AM

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Senior Account Manager - Benefits
  • Summit Financial Group, Inc.
  • Tulsa, OK
  • JOB SUMMARY/ORGANIZATIONAL IMPACT: The Senior Benefits Account Manager (“SBAM”) reports directly to the President, Benef...
  • 3/25/2024 12:00:00 AM

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Remote Sales Consultant
  • Bein Financial Group
  • Tulsa, OK
  • Remote Sales Consultant Are you tired of being confined to a traditional office setting for your sales career? With Our ...
  • 3/25/2024 12:00:00 AM

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Assistant Restaurant Manager
  • Five Guys Burgers and Fries
  • Beggs, OK
  • **Assistant Restaurant Manager** **COMPANY:** H & I Burgers, LLC **REQ #:** 3738453 **LOCATION:** 1365 Berryville Ave, W...
  • 3/25/2024 12:00:00 AM

Muskogee (/məˈskoʊɡiː/) is a city in and the county seat of Muskogee County, Oklahoma, United States. Home to Bacone College, it lies approximately 48 miles southeast of Tulsa. The population of the city was 39,223 as of the 2010 census, a 2.4 percent increase from 38,310 at the 2000 census, making it the eleventh-largest city in Oklahoma. The 1951 film Jim Thorpe – All-American, starring Burt Lancaster, was filmed on the campus of Bacone Indian College at Muskogee. Three feature films were recently shot in Muskogee: Salvation (2007), Denizen (2010), and American Honey (2016). Muskogee is an ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Provider Relations Manager jobs
$94,949 to $136,971
Muskogee, Oklahoma area prices
were up 1.2% from a year ago

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