Managed Care Provider Relations Manager jobs in Texas

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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Medical Managed Care Case Manager
  • Brookdale Corporate
  • Houston, TX FULL_TIME
  • Overview

    The Medical Managed Care Case Manager position assists with referral management, coordination of provider approvals, and provides comprehensive clinical and rehabilitation updates with managed care and BPCI/Bundled payment payer groups.  This role will support patients on our skilled nursing units in TX.    Regional Case Managers ensure appropriate level of reimbursement for patient specific care needs and work collaboratively with interdisciplinary team and providers.  Make Lives Better Including Your Own. If you want to work in an environment where you can become your best possible self, join us!  You’ll earn more than a paycheck; you can find opportunities to grow your career through professional development, as well as ongoing programs catered to your overall health and wellness.  Full suite of health insurance, life insurance and retirement plans are available and vary by employment status.  Additional benefits offered include, but are not limited to:
    • Tuition Reimbursement
    • Pet Insurance
    • Adoption Reimbursement Benefits
    • Variety of Associate Discounts
    Veterans, transitioning active duty military personnel, and military spouses are encouraged to apply.  Please note, Brookdale is committed to complying with all applicable laws and regulations regarding mandatory COVID-19 vaccination.

     

    To support our associates in their journey to become a U.S. citizen, Brookdale offers to advance fees for naturalization (Form N-400) application costs, up to $725, less applicable taxes and withholding, for qualified associates who have been with us for at least a year.

    Responsibilities

    The Regional Case Manager position assists with referral management, coordination of provider approvals, and provides comprehensive clinical and rehabilitation updates with managed care and BPCI/Bundled payment payer groups. Regional Case Managers ensure appropriate level of reimbursement for patient specific care needs and work collaboratively with interdisciplinary team and providers.

     

  • Leads the case management process from admission through patients’ next lower level of care.
  • Fosters and develops partnerships with insurance case managers to ensure all patient updates are delivered timely.
  • Reviews, analyzes, and facilitates authorizations of referral information in coordination with the sales & marketing team, business office representative, interdisciplinary team, Director of Clinical Services, Health Care Administrator, legal representative, and claims/insurance agency as indicated.
  • Negotiates rates for improved reimbursement if necessary to capture additional care needs and ancillary services to support patients’ care needs in a timely manner.
  • Communicates and provides documentation periodically to insurance providers for approval of coverage during skilled stay.
  • Knowledge of all managed care contracts that is under management.
  • Partners with nursing to collaborate with health care specialists to identify necessary ancillary services and support.
  • Demonstrates compliance with facility and departmental safety and security policies and practices.
  • Assists with educating hospital team members and physicians on case manager role at the community.
  • Attends Weekly Medicare/IDT meeting to ensure patient care needs and payer expectations are coordinated.
  • Coordinates the delivery of the Notice of Non-Coverage to resident and/ or legal representative in a timely matter.
  • Provides excellent written and verbal communication to patients/families, inpatient case managers, managed care organizations, providers, and other skilled nursing team members.
  • This job description represents an overview of the responsibilities for the above referenced position. It is not intended to represent a comprehensive list of responsibilities. An associate should perform all duties as assigned by his/her supervisor.

    Qualifications

    Minimum Requirements

    • A minimum of 2 years of related clinical experience; experience in rehabilitation, post-acute care, and/ or case management.
    • Licensed Nurse is highly preferable.
    • Demonstrated accountability and skills in analysis, problem solving, decision making, time management, and oral and written communications.
    • Familiarity with the resources available regarding the regulations and parameters of third-party reimbursement.

     

    Certifications, Licenses, and Other Special Requirements

    None

     

    Physical Demands and Working Conditions

    • Standing
    • Walking
    • Sitting
    • Use hands and fingers to handle or feel
    • Reach with hands and arms
    • Vision
    • Requires interaction with co-workers, residents or vendors
    • Occasional weekend, evening or night work if needed to ensure shift coverage
    • On-Call on an as needed basis
    • Requires Travel:  Occasionally
    • Requires Driving: Drives self (Tier 2)

     

    Brookdale is an equal opportunity employer and a drug-free workplace.

    Salary Range Information

    $62,490 - $79,608 / year
  • 1 Month Ago

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Managed care
  • InsideHigherEd
  • Lubbock, TX FULL_TIME
  • Extended Job Title Managed Care Org Level 1 Texas Tech Univ Health Sciences Ctr Org Level 7 512601 - Ophthalmology Dept Lbk Genl Position Description Performs supervisory and coordinative work in the ...
  • 15 Days Ago

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Territory Client Account Manager - Texas
  • Managed Mobile
  • Dallas, TX FULL_TIME
  • The Territory Client Account Manager will learn the details of the sales process as well as develop the skills necessary to execute client acquisition and retention. The Territory Client Account Manag...
  • 9 Days Ago

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Managed Care Virtual Liaison
  • Home Care Providers of Texas
  • Dallas, TX FULL_TIME
  • Thanks to our continued success, Home Care Providers of Texas is seeking a Managed Care Virtual Liaison in the Dallas, TX and surrounding area!The Managed Care Virtual Liaison is responsible for the p...
  • 16 Days Ago

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Product Manager - TPA & Provider Solutions
  • TPA & Provider Solutions - Employer Direct Healthcare
  • Dallas, TX FULL_TIME
  • About Employer Direct HealthcareEmployer Direct Healthcare is focused on giving access to quality & affordable healthcare for our members. We understand and have experienced the challenges of navigati...
  • 17 Days Ago

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RN Care Coordinator
  • Provider Partners Health Plan
  • Wichita Falls, TX FULL_TIME
  • RN Care Coordinator- 50% Travel within 1 hr Wichita Falls- Mileage reimbursed POSITION SUMMARY * NO CALL* The Nurse Care Coordinator will play a key role in the execution of the Provider Partners Heal...
  • 7 Days Ago

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Relationship Manager
  • Israel Discount Bank of New York
  • New York, NY
  • Company Description For more than 70 years, IDB Bank has made it our mission to be the best bank for our clients by putt...
  • 3/29/2024 12:00:00 AM

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Relationship Manager
  • Sabal Trust Company
  • Tampa, FL
  • Job Description Job Description Position: Trust & Financial Services Associate: Sabal Trust Company, Florida's largest e...
  • 3/29/2024 12:00:00 AM

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Relationship Manager
  • Brookstone Capital Management
  • Wheaton, IL
  • About Us: Brookstone Capital Management is a dynamic and forward-thinking national Financial Services firm with ~$9B in ...
  • 3/28/2024 12:00:00 AM

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Relationship Manager
  • BHI
  • Miami, FL
  • Job Summary This positions primary responsibility is new business development and existing / new account management. Ori...
  • 3/28/2024 12:00:00 AM

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Relationship Manager
  • Claire Myers Consulting
  • Wichita Falls, TX
  • Our client is a dynamic, boutique wealth management firm with a mission to educate the community on all things financial...
  • 3/28/2024 12:00:00 AM

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Relationship Manager
  • OPENLANE
  • Fredericksburg, VA
  • Who We Are: At AFC (Automotive Finance Corporation) we fuel the entrepreneurial dream in our community. For more than 30...
  • 3/26/2024 12:00:00 AM

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Relationship Manager
  • WaFd Bank
  • Medford, OR
  • Min: USD $85,000.00/Yr. Max: USD $130,000.00/Yr. Job Summary: A Relationship Manager is responsible for developing a bus...
  • 3/26/2024 12:00:00 AM

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Relationship Manager
  • BSF
  • Walnut Creek, CA
  • POSITION OVERVIEW: The Relationship Manager is responsible for developing and managing client relationships with local b...
  • 3/26/2024 12:00:00 AM

Texas (/ˈtɛksəs/, locally /ˈtɛksɪz/; Spanish: Texas or Tejas Spanish pronunciation: [ˈtexas] (listen)) is the second largest state in the United States by both area and population. Geographically located in the South Central region of the country, Texas shares borders with the U.S. states of Louisiana to the east, Arkansas to the northeast, Oklahoma to the north, New Mexico to the west, and the Mexican states of Chihuahua, Coahuila, Nuevo León, and Tamaulipas to the southwest, while the Gulf of Mexico is to the southeast. Houston is the most populous city in Texas and the fourth largest in the...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Provider Relations Manager jobs
$98,935 to $142,721

Managed Care Provider Relations Manager in Trenton, NJ
Rizk says McKesson has created a collegial relationship by reaching out to providers.
January 03, 2020
Managed Care Provider Relations Manager in Gary, IN
Aetna (57% favorable/37% unfavorable) has turned around providers by changing leadership and addressing provider concerns.
February 24, 2020
Managed Care Provider Relations Manager in Birmingham, AL
Providers "want legitimate, honest P4P programs, data exchange, streamlined business processes, and clarity.
November 28, 2019