Managed Care Provider Relations Manager jobs in Nevada

Overview

Are you looking for a career to be a part of a great culture of support and growth? Then welcome you made it to the job posting for you!

At Nevada Health Centers, we look for people who will embrace our vision of excellent service. Who have the desire to serve and make a difference in our communities. We value as an organization diversity and inclusion. If you can see yourself here and can deliver a positive impact, then check out some of the details below!

The Provider Relations Manager maintains the provider network with all NVHC payers and oversees contract coordination, credentialing, privileging, and provider enrollments for the medical, behavioral health, residents, pharmacy, dental providers, and all clinical staff. This position will work closely with all providers and clinical staff to obtain all information necessary to complete credentialing and privileging requirements; coordinates hospital applications and re-appointments for providers as needed; maintains current credentials for all active providers; complies with all HIPAA and HRSA rules and regulations. Furthermore, the Provider Relations Manager oversees the coordination, compilation, and preparation of reports pertaining to existing practitioners as requested; prepares all correspondence associated with the credentialing and reappointment process; provides verification of employment and malpractice coverage for all medical and dental providers.

Responsibilities

Credentialing and Privileging

• Manages and maintains all credentialing and privileging as required by Health Resource and Service Administration (HRSA), to include all clinical staff
• Oversees license applications, onboarding
• Manages Source of Truth document for Revenue Cycle

Provider/Clinical Staff Contracting

• Manages and maintains government and private insurance contracts
• Oversees the Initial Provider Medicare, Medicaid and all commercials and managed care applications
• Oversees the re-enrollment process enrollments with private insurance, hospitals, Medicare and Medicaid
• Maintains NV Standardized Insurance application and any additional documentation necessary for enrollments

Provider Relations

• Responsible for managing the Provider Relations Privileging and Licensing Specialists and the Provider Relations Coordinator
• Supports staff for times of increased volume
• Fielding communication and needs from other departments
• Ensures provider employment contracts are maintained in a compliance and confidential manner
• Maintains/updates the Provider Compliance handbook to insure that all processes are documented and current
• Manages and maintains effective office procedures and efficient workflows establishes and maintains harmonious working relationships with superiors, co-workers, customers or clients, the medical/dental staff
• Responsible with initial applications and reapplications for licensing boards as required
• Takes action authorized by the VP of Provider Relations & Strategic Partnerships utilizing initiative and judgment to see that matters requiring attention are referred to delegated authority or handled as needed
• Provides direction and expertise to clinical leadership and is knowledgeable of NVHC Policies and Procedures and relevant state law, federal and HRSA standards, as they relate to clinical/provider
• Offers support and assistance for other committees including Medical Executive Committee, Quality Improvement, Safety, and others on an as needed
• Manages of building credentials file, offer letters, employment contracts, Personal Change Forms (PCF), supervision and collaborative agreements, auditing and quality management of Provider files
• Development and documentation of process improvement.
• Develop and maintain definitions of scope for all provider types
• Manages provider offboarding process and management of providers leaving the organization
• Troubleshooting enrollment issues/communication with plans and escalation of enrollment issues

Risk Management

• Provides leadership and guidance for policy/procedure/reports and legal as needed
• Drafts annual application and supporting documentation for Federal Tort Claims Act malpractice coverages and is responsible to stay up to date with any regulatory changes regarding FTCA application and the Claims Management.
• Responsible for management and processing of claims-related activities and serves as claims point of
• Participates in various committees that has oversight of quality, risk management and claims management.
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Qualifications

Requirements: 

• Five (5) years of Health Care experience including contracting, and Two (2) years of college is required, a college degree is preferred
• A minimum of two (5) years of credentialing experience is desirable

About our company:

Established in 1977, Nevada Health Centers is the largest provider of primary care for the uninsured, underinsured, and geographically isolated, with 18 health centers; three mobile health programs; and seven Women, Infants, and Children offices. Our mission: To provide access to quality healthcare services throughout Nevada. Our vision: To create an integrated, provider-led healthcare system that supports the delivery of safe, effective, quality-based primary care to all Nevadans.

Nevada Health Centers will provide equal opportunity employment to all employees and applicants for employment. No person shall be discriminated against in employment because of race, color, gender, age, national origin, ancestry, religion, physical or intellectual disability marital status, parental status, sexual orientation or any other category protected by law.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee is occasionally required to stand; walk; stoop, kneel, or crouch. The employee must regularly lift and/or move up to 20 pounds.