Provider Network Director jobs in Caldwell, ID

Provider Network Director directs and develops a healthcare provider network. Designs and administers policies and services that comply with all contractual and regulatory requirements. Being a Provider Network Director requires a bachelor's degree. Typically reports to top management. The Provider Network Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. To be a Provider Network Director typically requires 5+ years of managerial experience. (Copyright 2024 Salary.com)

M
Provider Relations Network Manager- Idaho
  • Mount Carmel Health System
  • Boise, ID FULL_TIME
  • Employment Type:
    Full time
    Shift:

    Description:

    The Provider Relations & Network Manager is responsible for a full range of provider relations and service interactions in MediGold's Idaho market, including: contracting and recruitment, issue resolution and escalations, strategy development and execution, education, and retaining MediGold Contracted Providers. This position serves as the primary point of contact for the Providers and will require extensive relationship building, driving the resolution of complex issues, and MediGold brand building. The individual will also assist the Director for Provider Contracting and Network Development to develop provider collaborations that ensure network growth and quality/efficiency targets.

    Responsibilities

    • Recruit providers to build a cost effective and high quality provider network within MediGold guidelines.
    • Serve as the MediGold point of contact within the Provider network; Act as the MediGold Subject Matter Expert and brand ambassador.
    • Addresses customer complaints by directly handling the issue, working with the correct department(s) to resolve, or escalating as required.
    • Engage Providers to develop, coordinate, and lead training and distribution of materials.
    • Proactively drive communications with Providers via telephone/email and onsite visits.
    • Collaborates with the Director - Provider Contracting and Network Development to develop communication goals, strategies, and plans.
    • Negotiates provider contracts within MediGold guidelines and financial standards.
    • Collaborates with the Managers of Member and Provider Communications to oversee the completion of all provider communication content and materials.
    • Manages and works with other internal partners to facilitate provider Joint Operating Committee (JOC) Meetings.
    • Develops, implements, and manages policies, and procedures as assigned.
    • Assists Director and/or Sr. Director with the Medical Delivery Systems budget.
    • Manages successful implementation of provider contracts, including interpretation of payment and reimbursement terms.
    • Maintains excellent working relationships with MediGold's provider network, internal department management, other business partners, and Mount Carmel Health System related entities.
    • Exhibits a professional appearance and demeanor.
    • Travel to regional client locations and corporate office as required.
    • Use of personal vehicle for Provider visits required.
    • All other duties as assigned.

    Requirements

    • Education: Bachelor's degree in Healthcare Administration, Finance, related field or equivalent experience.
    • Experience: Minimum five years of experience with a Health Plan or Health Provider. Prior contracting and network development experience highly preferred
    • Knowledge of physician claims coding and Provider reimbursement payment methodologies; Ability to interpret Provider contracts
    • Willingness to be the point of contact for the MediGold brand within the Provider network
    • Establish and maintain relationships with Providers to ensure quality and satisfaction of services provided
    • Capacity to address complex problems including claims issues and customer service complaints; work with other departments to achieve resolution of the issues
    • Demonstrated ability to identify areas of opportunity within Provider networks for improving overall efficiency and quality
    • Working knowledge of protocols and procedures of Centers For Medicare and Medicaid Services
    • Proven ability to work effectively with internal and external multi-disciplinary teams across all levels of the organization
    • Proven track record of managing multiple priorities and executing tasks within tight timeframes
    • Experience in identifying and executing process improvement needs
    • Must possess a high degree of motivation, initiative, and organization ability
    • Valid driver's license

    Discovering opportunities, support and excellence – all while making a real difference in patients’ lives – begins at Mount Carmel. Find a new beginning and advance your career with us.

    Mount Carmel and all its affiliates are proud to be equal opportunity employers. We do not discriminate on the basis of race, gender, religion, physical disability or any other classification protected under local, state or federal law.

    Our Commitment to Diversity and Inclusion


    Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

  • 4 Days Ago

P
Outpatient Physical Therapist/Clinic Director
  • Physical Rehabilitation Network
  • Boise, ID FULL_TIME
  • Sign-On Bonus | Clinical Pathways | $1,500 CEU | 3 Weeks of Vacation | $750 Monthly Incentive! |Developing Residency Programs RehabAuthority (a Physical Rehabilitation Network brand) is an outpatient ...
  • 20 Days Ago

C
Dental Assistant
  • Compass Medical Provider, LLC
  • Boise, ID CONTRACTOR,PART_TIME
  • Compass Medical Provider is seeking an experienced Dental Assistant to provide precise dental exams and treatment on Thursdays for the Idaho National Guard located in Boise, ID. Dental Exams include u...
  • 1 Day Ago

M
Provider
  • Mana Resources
  • Nampa, ID FULL_TIME
  • About Mana Resources : Since 2008 our agency has been providing services to youth around the state that are aging out of foster care and juvenile corrections who need a plan for becoming self-reliant....
  • 28 Days Ago

W
Network Administrator
  • WinCo Foods
  • BOISE, ID OTHER
  • About Us Join us at WinCo Foods, where we're more than just a grocery retailer - we're a growing family of over 140 supermarkets in 10 states with over 22,000 employee owners. Our purpose is to make t...
  • 23 Days Ago

I
Network Administrator
  • Idaho Central Credit Union
  • Meridian, ID OTHER
  • Overview The primary area of responsibility is to support the ICCU network and Unified Communications systems through operational tasks and troubleshooting issue. This role performs high quality suppo...
  • Just Posted

Filters

Clear All

  • Filter Jobs by companies
  • More

0 Provider Network Director jobs found in Caldwell, ID area

C
Sales Director
  • Celestica
  • Boise, ID
  • Req ID: 120204 Remote Position: Yes Region: Americas Country: USA **General Overview** **Functional Area:** MBD - Market...
  • 3/28/2024 12:00:00 AM

E
Human Resources Director
  • Encompass Health
  • Boise, ID
  • The Human Resources Director (HRD) is a Senior Leader that plans, organizes, and directs all aspects of human resources ...
  • 3/27/2024 12:00:00 AM

S
Regional Sales Manager Northwest region - REMOTE
  • Securly Inc
  • Boise, ID
  • **Regional Sales Manager Northwest region - REMOTE** at Securly Boise, Idaho, United States (remote) **326% Growth -** S...
  • 3/27/2024 12:00:00 AM

R
Chemical Sales Manager - Northwest
  • Ryko Solutions, Inc.
  • Boise, ID
  • ** Chemical Sales Manager - Northwest** **Job Category****:** Sales **Requisition Number****:** CHEMI02447 Showing 1 loc...
  • 3/27/2024 12:00:00 AM

V
Regional Sales Manager
  • Verified First
  • Meridian, ID
  • Note from CEO to the RSM candidates: "I was and still am a sales guy in heart. When we built Verified First we built the...
  • 3/26/2024 12:00:00 AM

A
Information Technology Infrastructure Manager
  • Amalgamated Sugar Company
  • Boise, ID
  • IT Infrastructure Manager Amalgamated Sugar Company-Boise, Idaho The IT Infrastructure Manager plays a critical role in ...
  • 3/25/2024 12:00:00 AM

C
Envista Director, EBS Commercial (Remote-Brea, CA)
  • Careerbuilder
  • Garden City, ID
  • Envista Holdings Corporation Envista Director, EBS Commercial (Remote-Brea, CA) Boise , Idaho Apply Now Reporting direct...
  • 3/25/2024 12:00:00 AM

C
Senior Country Clinical Quality Management Lead (Remote)
  • Careerbuilder
  • Garden City, ID
  • Merck Senior Country Clinical Quality Management Lead (Remote) Boise , Idaho Apply Now It is critical that, for all comp...
  • 3/25/2024 12:00:00 AM

Caldwell (locally /ˈkɑːlwɛl/) is a city in and the county seat of Canyon County, Idaho, United States. The population was 46,237 at the 2010 census. Caldwell is considered part of the Boise metropolitan area. Caldwell is the location of the College of Idaho and College of Western Idaho. Caldwell is located at 43°39′30″N 116°40′49″W / 43.65833°N 116.68028°W / 43.65833; -116.68028 (43.658239, -116.680390). According to the United States Census Bureau, the city has a total area of 22.11 square miles (57.26 km2), of which, 22.06 square miles (57.14 km2) is land and 0.05 square miles (0.13 km2)...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Network Director jobs
$159,285 to $205,789
Caldwell, Idaho area prices
were up 2.5% from a year ago

Provider Network Director in Moline, IL
You can keep costs low when using your plan by staying “in network,” or using the doctors and other health care providers that are in your plan’s network.
December 27, 2019
Provider Network Director in Sacramento, CA
A healthcare provider network is a compilation of all doctors, physicians, hospitals, clinics, pharmacies, etc.
February 22, 2020
Provider Network Director in Springfield, OR
If the plan name includes any of the following things, your plan does NOT use the standard network.
February 12, 2020