PROVIDER NETWORK MANAGER jobs in Michigan

PROVIDER NETWORK MANAGER manages the operations of a healthcare provider network. Responsible for establishing and maintaining processes and systems to provide routine services to members including contract management and credentialing. Being a PROVIDER NETWORK MANAGER recruits, hires, trains, and measures performance of staff to provide effective and operations within budget. May be involved with the design and operations of database systems used to manage provider data and produce reports and analysis. Additionally, PROVIDER NETWORK MANAGER requires a bachelor's degree. Typically reports to top management. The PROVIDER NETWORK MANAGER 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 NETWORK MANAGER typically requires 3+ years of managerial experience. (Copyright 2024 Salary.com)

D
Provider Network Manager
  • Detroit Wayne Integrated Health Network
  • Detroit, MI FULL_TIME
  • Under the supervision of the Director of Managed Care Operations, the Provider Network Manager is responsible for the overall coordination of the contracts between the Detroit Wayne Integrated Health Network (DWIHN) and the assigned network providers.


    PRINCIPAL DUTIES AND RESPONSIBILITIES:

    • Manages the contracts between (DWIHN) and the assigned network providers.
    • Serves as the primary liaison between the Network and the providers.
    • Leads a "virtual team" of interdepartmental experts to assist, monitor and manage the network providers
    • Collaborates with Finance, Information Technology, Recipient Rights, Quality Management, and Clinical Services to ensure that all contractual issues/concerns are addressed.
    • Serves as the providers primary point of contact with the Network.
    • Facilitates the successful implementation of new contracts with providers by providing technical assistance.
    • Monitors, assesses and ensures that providers receive required and necessary training.
    • Protects the confidential and proprietary nature of provider operations.
    • Explains and interprets the Network's policies, procedures and goals to the provider network.
    • Resolves problems; responds to issues, requests and complaints; and answers questions for the provider network.
    • Collaborates with other Contract Managers to propose revisions to the Network's policies and procedures to improve interface with network providers.
    • Obtains and disseminates required provider network data for network development and maintenance.
    • Participates in the analysis of network provider performance data to ensure appropriate network utilization and identify needs for network modification and reconfiguration.
    • Facilitates provider network compliance and corrective action.
    • Responds to general public inquiries, problems and concerns.
    • Maintains documentation of all interactions with the provider network.
    • Submits monthly and quarterly written reports regarding provider network performance and progress.
    • Facilitates monthly/quarterly meetings with the provider network.
    • Prepares Board Actions as needed.
    • Monitors the contracting process from board action to approval.
    • Maintains oversight of the contracting process with network providers to ensure compliance with all procurement requirements.
    • Performs related duties as assigned.

    KNOWLEDGES, SKILLS AND ABILITIES (KSA'S)

    • Knowledge of DWIHN policies, procedures and practices.
    • Knowledge of the DWIHN provider network and community resources.
    • Knowledge of the Michigan Mental Health Code.
    • Knowledge of MDHHS policies, rules, regulations and procedures.
    • Knowledge of Federal policies, rules, regulations and procedures as it relates to DWIHN.
    • Knowledge of compliance standards.
    • Knowledge of regulatory and industry best practice standards.
    • Knowledge of Community Mental Health Services Programs (CMHSP) and Prepaid Inpatient Health Plans (PIHP).
    • Management skills.
    • Training skills.
    • People management skills.
    • skills.
    • Action planning skills.
    • Conflict Resolution skills
    • Corrective Action skills.
    • Assessment skills.
    • Organizational skills.
    • Planning skills.
    • Accuracy skills.
    • Analytical skills.
    • Time Management skills.
    • Report writing skills.
    • Negotiation skills.
    • .
    • Communication skills.
    • Collaboration skills.
    • Implementation skills.
    • .
    • Relationship-building skills.
    • Computer skills (Word, Excel, Access, Power Point, Outlook, Teams)
    • Ability to communicate orally.
    • Ability to communicate in writing.
    • Ability to work effectively with others.
    • Ability to work with an ethnically, linguistically, culturally, economically and socially diverse population.
    • Judgement/Reasoning ability.

    REQUIRED EDUCATION:

    A Bachelor's Degree from a recognized college or university in the Human Services, the Social Services, Nursing, Public Health, Public Administration, Healthcare Administration, Health Management, Business Administration, or a related field.

    REQUIRED EXPERIENCE:

    Five (5) years of post-degree professional experience in behavioral healthcare or community mental health.

    Experience must include management, administrative or supervisory duties and responsibilities.

    NOTE: A Master's Degree in the educational fields required by this posting may be substituted for two (2) years of the required experience.

    REQUIRED LICENSE(S).

    A valid State of Michigan Driver's License with a safe and acceptable driving record.

    WORKING CONDITIONS:

    Work is usually performed in an office setting but requires the employee to drive to different sites throughout Wayne County and the State of Michigan. This position can work remotely with supervisory approval. Currently this position is primarily a remote position.

    This description is not intended to be a complete statement of job content, rather to act as a general description of the essential functions performed. Management retains the discretion to add or change the position at any time.

    Please Note: DWIHN requires proof of being fully vaccinated for COVID-19 as a condition of employment. Medical or religious accommodations or other exemptions that may be required by law, will be approved when properly supported. Further information will be provided during the recruitment process.

    The Detroit Wayne Integrated Health Network is an Equal Opportunity Employer

     

  • 3 Days Ago

D
Provider Network Manager - Housing
  • Detroit Wayne Integrated Health Network
  • Detroit, MI FULL_TIME
  • Under the general supervision of the Director of Contract Management, the Provider Network Manager - Housing is responsible for the oversight and coordination of contracts between DWIHN, the State of ...
  • 3 Days Ago

D
Provider Network Manager
  • Detroit Wayne Mental Health Authority
  • Detroit, MI FULL_TIME
  • Under the supervision of the Director of Managed Care Operations, the Provider Network Manager is responsible for the overall coordination of the contracts between the Detroit Wayne Integrated Health ...
  • 4 Days Ago

D
Provider Network Manager - Housing
  • Detroit Wayne Mental Health Authority
  • Detroit, MI FULL_TIME
  • Under the general supervision of the Director of Contract Management, the Provider Network Manager – Housing is responsible for the oversight and coordination of contracts between DWIHN, the State of ...
  • 4 Days Ago

C
Provider Network Manager
  • Community Mental Health for Central Michigan
  • Mount Pleasant, MI FULL_TIME
  • LOCATION 301 S Crapo St, Mount Pleasant, MI 48858 SCHEDULE This is a full time, hybrid position, 40 hours per week. The schedule is generally 8am - 5pm, Monday through Friday however there is flexibil...
  • 1 Month Ago

A
Pharmacy Technician
  • Advanced Care Provider Network
  • Adrian, MI FULL_TIME
  • We are currently looking for a full time Pharmacy Technician! Come be part of an innovative healthcare team that is taking care of people all over the Adrian area! Reports to: Pharmacy Manager or desi...
  • 20 Days Ago

A
Manager Provider Network Management
  • AmeriHealth Caritas
  • Palm Beach Gardens, FL
  • **Manager Provider Network Management** Location: Palm Beach Gardens, FL Primary Job Function: Medical Management ID**: ...
  • 3/28/2024 12:00:00 AM

C
Regional Provider Network Manager (Midwest region)
  • Christian Care Ministry
  • Nashville, TN
  • The range for this role is $70,000 - $95,000 Actual base pay will be determined based on a successful candidate's work l...
  • 3/28/2024 12:00:00 AM

C
Operations Analyst: PE (Part-Time)
  • CertifyOS
  • New York, NY
  • OPERATIONS ANALYST: Payor Enrollment Remote | USA About CertifyOS: We are on a mission to change how the US healthcare i...
  • 3/28/2024 12:00:00 AM

R
Service Provider Manager (SPM) (Referral Management Clerk) - Eglin AFB, FL
  • Reef Systems
  • Eglin Afb, FL
  • Service Provider Manager (SPM) (Referral Management Clerk) - Eglin AFB, FL Background/Experience : Shall read, understan...
  • 3/27/2024 12:00:00 AM

C
Sales AVP or higher - Digital and IT services - Healthcare payer sector
  • Confidential
  • Valenco Inc. (www.valencoinc.com) is an executive search company focused on sales and sales leadership roles for the tec...
  • 3/27/2024 12:00:00 AM

C
Operations Manager - Provider Management
  • CorVel
  • Fort Worth, TX
  • The CERIS Operations Manager is responsible for overseeing all aspects of the department including Personnel Hiring, Qua...
  • 3/26/2024 12:00:00 AM

M
In-House IPA Representative
  • MedPOINT Management
  • Los Angeles, CA
  • Job Description Job Description Summary Under the general direction of the Provider Network Operations (PNO) – Network M...
  • 3/24/2024 12:00:00 AM

A
Job Page
  • Arizona State Hospital
  • Phoenix, AZ
  • AHCCCS Arizona Health Care Cost Containment System Accountability, Community, Innovation, Leadership, Passion, Quality, ...
  • 3/24/2024 12:00:00 AM

Michigan consists of two peninsulas that lie between 82°30' to about 90°30' west longitude, and are separated by the Straits of Mackinac. The 45th parallel north runs through the state—marked by highway signs and the Polar-Equator Trail—along a line including Mission Point Light near Traverse City, the towns of Gaylord and Alpena in the Lower Peninsula and Menominee in the Upper Peninsula. With the exception of two small areas that are drained by the Mississippi River by way of the Wisconsin River in the Upper Peninsula and by way of the Kankakee-Illinois River in the Lower Peninsula, Michigan...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for PROVIDER NETWORK MANAGER jobs
$106,543 to $133,491

PROVIDER NETWORK MANAGER in Tucson, AZ
There are different Location Providers, which one is the most accurate? The GPS Provider or the Network Provider.
January 08, 2020
PROVIDER NETWORK MANAGER in Saint Louis, MO
Healthcare providers are continually struggling with the increasing pressure to cut down on patient costing, providing higher quality service, increased accessibility, etc.
January 10, 2020
PROVIDER NETWORK MANAGER in Norfolk, VA
5+ years of experience in a network management-related role, such as contracting or provider services.
February 05, 2020