Managed Care Provider Relations Manager jobs in North Carolina
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)
Recently Added Managed Care Provider Relations Manager jobs
Provider Operations Managed Care Consultant
- North Carolina Dept of Health and Human Services
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UNKNOWN, NC
FULL_TIME
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Description of Work
**This position is exempt from the State Human Resources Act**
TELEWORK AVAILABILITY: We trust our employees to be self-motivated and successful in hybrid/remote roles; NC Department of Health and Human Services offers work from home options and variable work schedule flexibility for this position.
Division of Health Benefits employees with an approved hybrid telework schedule are currently expected to work onsite at their assigned duty station at least 4 working days per month or more as needed for business operations. Telework options are subject to change at the discretion of management. More information on this arrangement may be obtained at the time of interview.
This position’s duty station is assigned to Dix Campus in Raleigh, North Carolina.
Position SummaryNC Medicaid recognizes the need to promote access to care by enrolling all providers in a timely manner and is committed to ensuring the provision of quality care for our citizens. Provider Operations assumes responsibility for an extensive amount of oversight and structured monitoring activities of the Fiscal Agent, Pre-paid Health Plans/Standard Plan, and Tailored Plan, in addition to other current and expected vendors in relation to Provider Enrollment, Provider Services, Service Level Agreements, and engagement with other high priority operational components.
The Provider Operations Managed Care Consultant serves as a lead assisting unit management in the monitoring of managed care vendors to ensure their compliance with contractual obligations as well as to assist the manager with any other assigned duties. The Managed Care team is one of the sub teams within the Provider Operations business unit that reports to the Associate Director. The Managed Care Consultant III position will report to the Provider Operations Managed Care Manager.
Job Specific Responsibilities- Serve as team lead for all Provider Operation activities related to Medicaid managed care.
- Ensure Managed Care vendors are working within the scope of federal and state rules and regulations and meeting contractual obligations.
- Engage with vendors re: Contract Performance process for addressing non-compliance, including initiation of Notice of Deficiency, Corrective Action Plan, as needed.
- Document monitoring activities and adverse findings in accordance with protocol to include preparing reports, summarize monitoring activity outcomes, and results; discuss monitoring activity outcome and results; engage with vendors, internal staff, and other business units as needed to bring resolution.
- Communicate and collaborate with management based on the impact and severity of findings, issues and concerns related to managed care programs.
Knowledge, Skills and Abilities / Competencies
To receive credit for all of your work history and credentials, you must list the information on the application form. Any information listed under the text resume section or on an attachment will not be considered for qualifying credit. Qualified applicants must document on the application that they possess all of the following:- Experience communicating effectively with internal and external stakeholders.
- Strong proficiency in Microsoft Office suite, including Outlook, Excel, and Word.
- Ability to interpret and implement federal and/or state laws and regulations as it relates to the program.
- Proficient at preparing and interpreting financial and operational reports.
- Broad knowledge of insurance, operations, programs, policy and procedure along with experience or insight into provider contracting and operations.
- General knowledge of the varieties of primary health care delivery systems and their operation; the principles of community organization; and/or the principles and practices of managed health care, particularly as applied to Medicaid programs.
- Considerable knowledge of compliance monitoring, quality control, and/or quality assurance, preferably in an insurance or healthcare environment.
Management Preferences:- Previous and proven work experience at Division of Health Benefits/NC Medicaid.
- Familiarity with relevant and current NC Medicaid operations.
- Medicaid and/or health insurance industry experience, including experience with project management.
- Experience managing a team or serving as a team lead in an enrollment or credentialing role in a government agency, government vendor, or large healthcare organization.
- Familiarity with managed care contracting.
Minimum Education and Experience Requirements
Some state job postings say you can qualify by an “equivalent combination of education and experience.” If that language appears below, then you may qualify through EITHER years of education OR years of directly related experience, OR a combination of both. See oshr.nc.gov/experience-guide for details.
Master's degree in a discipline relative to the program from an appropriately accredited institution and four years of related experience; or
Bachelor’s degree in a discipline relative to the program area from an appropriately accredited institution and six years of related experience; or
an equivalent combination of education and experience.
Degrees must be from appropriately accredited colleges or universities.Supplemental and Contact Information
The North Carolina Department of Health and Human Services is an Equal Opportunity Employer.
Pre-employment criminal background checks are required for all positions with the Division of Health Benefits (DHB).
About NC Medicaid (Division of Health Benefits)
The North Carolina Department of Health and Human Services (NCDHHS) works closely with beneficiaries, health care professionals, community leaders and advocacy groups; local, state and federal entities; and other community partners vested to improve the health and safety of all North Carolinians by providing essential human services. NCDHHS is one of the largest, most complex agencies in the state, with about 17,000 employees.
The Division of Health Benefits (DHB) within NCDHHS is committed to advancing innovative solutions that improve health, promote well-being and foster independence for all North Carolinians. DHB manages and oversees North Carolina Medicaid, NC Medicaid Managed Care and other programs that provide access to services and supports for parents, children, seniors, people with intellectual / developmental disabilities, and behavioral health, substance use and traumatic brain injury disorders. With a budget over $21 billion in state and federal funds per fiscal year, DHB ensures that more than 96,000 enrolled providers are reimbursed for delivering covered services to 2.9 million beneficiaries.
Realizing the strength of DHB lies in its employees, DHB remains dedicated in its efforts to create and maintain a diverse, equitable and inclusive workplace environment.
Application ProcessApplicants are encouraged to apply for positions of interest, regardless of their current grade level and job classification. A pay increase may or may not result. Salary decisions are based on relevant education and experience, budget, and internal equity.
To be under consideration for this vacancy, all applicants must complete an online application using this link: https://www.governmentjobs.com/careers/northcarolina. If multiple applications are submitted to an individual posting, only the most recent application received prior to the posting close date will be evaluated for consideration.
Due to the volume of applications received, we are unable to provide information regarding the status of your application. To check the status of your application, please log in to your GovernmentJobs.com account. You will either receive a call or email to schedule an interview or an email notifying you when the job has been filled. For technical issues with your application, please call the NeoGov Help Line at 855-524-5627. If there are any questions about this posting other than your application status, please contact us at Medicaid.Recruitment@dhhs.nc.gov. - 25 Days Ago
Manager - Managed Care Contracting
- Candidate Experience site
-
Charlotte, NC
FULL_TIME
- Job Summary Responsible for managed care portfolio performance for assigned payors. Work with Management on implementation of contracting strategy for the System. Independently negotiate contract lang...
- Just Posted
PCA Personal Care Assistant/RCL RESIDENT CARE LIASION
- Medical Provider
-
Hampstead, NC
FULL_TIME,PART_TIME
- WE WANT YOU ON OUR TEAM!! Woodbury Wellness Center is currently seeking compassionate and driven candidates for our entry level Personal Care Assistant / Resident Care Liaison positions. This a non me...
- 1 Month Ago
Patient Relations Manager
- Hopscotch Primary Care
-
Boone, NC
FULL_TIME
- About the Role At Hopscotch Primary Care, we take a team approach to serve patient needs and provide the best care possible. Our goal is to provide the care each of us would want for ourselves or for ...
- 28 Days Ago
North Carolina - Regional Manager of Provider Relations
- KPH Healthcare Services
-
Matthews, NC
FULL_TIME
- Overview Travel: Daily travel required. Limited overnight travel required. Attendance at various business and management conferences may be required. Scope of Responsibilities: Responsible for sales i...
- 1 Month Ago
Managed Care Analyst / Managed Care / Full-Time
- Catawba
-
Claremont, NC
FULL_TIME
- Summary: Position is responsible for working with various internal and external customers regarding contract payor terms, policy/procedure updates, payor administration, variances/contract modificatio...
- 1 Month Ago
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- The Charles Schwab Corporation
-
San Francisco, CA
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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...
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Relationship Manager
- Rockland Trust
-
Hyannis, MA
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- Selby Jennings
-
New York, NY
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About North Carolina
North Carolina (/ˌkærəˈlaɪnə/ (listen)) is a state in the southeastern region of the United States. It borders South Carolina and Georgia to the south, Tennessee to the west, Virginia to the north, and the Atlantic Ocean to the east. North Carolina is the 28th-most extensive and the 9th-most populous of the U.S. states. The state is divided into 100 counties. The capital is Raleigh, which along with Durham and Chapel Hill is home to the largest research park in the United States (Research Triangle Park). The most populous municipality is Charlotte, which is the second-largest banking center in...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Provider Relations Manager jobs
$96,862 to $139,725
Most Popular Cities in North Carolina for Managed Care Provider Relations Manager Jobs
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