Provider Contracting Director is responsible for the operations of the provider contracts department. Ensures that provider contracts are processed to support accurate and efficient claims payments. Being a Provider Contracting Director oversees the formulation of provider contracts and specific terms. Analyzes contract data and provides financial projections. Additionally, Provider Contracting Director requires a bachelor's degree. Typically reports to top management. The Provider Contracting Director typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. To be a Provider Contracting Director typically requires 3+ years of managerial experience. (Copyright 2024 Salary.com)
POSITION SUMMARY:
Develops, implements, and monitors the person-centered Total Plan of Care (TPOC) for assigned members with behavioral health needs, developmental/intellectual disabilities, and/or substance use disorders, and other special populations; works closely with members, their families/guardians, their providers, and other members of their circle of support, to ensure the member is receiving the most appropriate care while addressing barriers to access to healthcare.
ESSENTIAL JOB FUNCTIONS:
2. Ensures that members’ health, safety, and service needs are met by working directly with the individual members, their families/guardians, their providers, and other members of their circle of support.
SECONDARY DUTIES AND RESPONSIBILITIES:
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