Provider Network Specialist jobs in South Carolina
Provider Network Specialist coordinates and evaluates the contracts of a healthcare provider network. Participates in the negotiation of contracts and prepares reports and analysis of contract details and statistics. Being a Provider Network Specialist distributes contract information, status updates, and other information within the organization. Requires a bachelor's degree. Additionally, Provider Network Specialist typically reports to a manager or head of a unit/department. The Provider Network Specialist gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Provider Network Specialist typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)
Recently Added Provider Network Specialist jobs
PRN Nurse Practitioner/ Flex Provider
- Matrix Medical Network
-
Townville, SC
FULL_TIME
- Company DescriptionMATRIX MEDICAL NETWORK is dedicated to helping in the care of Medicare Advantage plan members. Our success comes as the result of our extraordinary people, years of experience, advanced technology and powerful information management capabilities. In partnership with health plans and medical service providers, we are establishing new standards in health care quality, efficiency and effectiveness.Job DescriptionFLEX PROVIDER POSITION SUMMARY: The Flex Provider (fP) provides clinical assessment and care to assigned patients including assessments of health plan members in their homes and in facilities. The responsibilities include: adult/geriatric assessment, medical history, physical exam, medication reconciliation, diagnosis, and health education. Additionally, patient education, communication to the PCP, follow-up facilitated with the PCP, and case management referrals may also be part of any assessment. Clear documentation according to Matrix Medical Network (MMN) guidelines and protocols is required. Flex Providers will use previously acquired skills, education, medical training and experience as a medical professional in performing assessments. In the performance of the assessments, patient safety and well‐being is of the highest priority. Flex Providers are expected to maintain MMN standards for quality and customer service. Accordingly, the assessments performed by Flex Provider will be performed in accordance with currently approved and generally accepted professional medical standards and with MMN policies and procedures. From time to time, MMN will provide to Flex Providers copies of those policies and procedures. Other clinical care services may be required within the NP scope of practice. FLEX PROVIDER RESPONSIBILITIES: • Performs in-depth health risk assessments on all assigned members in patient homes or facilities • Works collaboratively with physicians, case managers, social workers, family members, key care givers and any appropriate ancillary medical personnel as appropriate • Responsible for identifying overall quality improvement activities through assessing and planning health care which is individualized to the member and consistent with Matrix Medical Network policies and protocols • Reviews and interprets the medical and social history of members • Performs appropriate screening procedures for members • Interprets laboratory data, recommends appropriate follow-up, reconciles medications • Refers members to PCP, case management and disease management programs as necessary. • Maintains positive control of all PHI information • Works closely with others within Matrix to create an effective and productive schedule • Is compliant with Matrix training/education requirements, OSHA, State Board of Nursing and other regulatory programs; seeks guidance for compliance-related concerns and adheres to all applicable laws, regulations and Matrix Medical Network policies and procedures QualificationsFLEX PROVIDER REQUIREMENTS: Knowledge, Skills and Abilities: • Must be able to demonstrate computer skills, including use of e-mail and Microsoft office word and excel • Must be able to demonstrate effective written communication skills including but not limited to writing reports and correspondence • Must be able to demonstrate effective verbal communication skills, including but not limited to speaking effectively to members, providers, families and staff and listening to members, providers and families • Demonstrated ability to meet deadlines, and use time effectively and efficiently. Concentrates efforts on priorities • Demonstrated successful experience working in an environment of change. Effectively copes with change and uncertainty; responds and “shifts gears” comfortably • Is dedicated to meeting the expectations and requirements of both external and internal customers, acts with customers in mind • Demonstrated ability to establish and maintain effective relationships with customers, and gain their trust and respect • Uses logical methods to solve problems with effective solutions; looks beyond the obvious for solutions • Is action oriented and sees challenges as opportunities Baseline Clinical Knowledge • Proven ability to perform comprehensive, adult/geriatric physical exam • Demonstrated ability to identify, diagnose and document chronic disease in adults • Demonstrated ability to recognize conditions, characteristics, and behaviors that place seniors at risk • Proven ability to pursue feedback, continuing education and professional development • Ability to effectively reconcile medications • Demonstrated ability to identify and document the needs of clinically complex patients Pertinent Clinical Work Experience which is relevant to Matrix • Must have: Minimum 1 year clinical experience as a Nurse Practitioner in geriatric, adult or family practice setting plus 3 – 5 years relevant RN experience or 2 -3 years Nurse Practitioner experience in geriatric, adult or family practice. Education • Bachelor of Science in Nursing preferred • Master’s Degree required OR commensurate experience and satisfactory completion of NP licensure Licensure/Certifications • Current RN and NP licensure in state of practice • Board certification by AANP or ANCC, in Adult, Family Practice and Geriatrics or Adult-Gerontology Primary Care • Current CPR certification Travel Requirements: Travel required • Must meet company driving standards • Must have valid state driver license and be able to drive a car • Must meet company’s automobile liability insurance standards and provide proof of coverage • Must be able to travel by public transportation, and airplanes • Must be able to independently travel to assigned locations Physical and Psychological Demands: • Requires prolonged sitting • Requires bending, stooping, twisting, kneeling, crouching, crawling and/or stretching from seated or standing positions • Requires eye-hand coordination and manual dexterity sufficient to operate medical equipment, computer tablet, computer keyboard, telephone, copier, calculator and other office equipment • Requires close vision, peripheral vision, and ability to adjust visual focus, hearing and smelling • Must be able to communicate information via telephone or computer • Requires moderate to intense concentration due to complexity of the job • Must be able to lift and/or move up to 75 lbs. • Must be able to observe “Universal Precautions” for blood-borne pathogens and body fluids Additional InformationEqual Opportunity EmployerMatrix Medical Network does not discriminate in practices or employment opportunities on the basis of an individual's race, color, national or ethnic origin, religion, age, sex, gender, sexual orientation, marital status, veteran status, disability, or any other proscribed category set forth in federal or state regulations.The preceding functions may not be comprehensive in scope regarding work performed by an employee assigned to this position classification. Management reserves the right to add, modify, change or rescind the work assignments of this position. Management also reserves the right to make reasonable accommodations so that a qualified employee(s) can perform the essential functions of the position.
- 1 Month Ago
Medical Practice Assistant - Provider Network Services
- Conway Medical Center
-
Myrtle, SC
FULL_TIME
- Position Summary: The Medical Practice Assistant (MPA) will assist with the administrative functions in a Physician’s office. The MPA will be responsible for scheduling patient’s appointments, adjust ...
- 2 Days Ago
Certified Medical Assistant - Provider Network Services
- Conway Medical Center
-
Conway, SC
OTHER
- INVITES YOU TO JOIN OUR TEAM!! Position Summary: The Certified Medical Assistant- PNS (CMA) will be responsible for accompanying patients to exam rooms, preparing patients for exams, performing and do...
- 6 Days Ago
Licensed Practical Nurse - Provider Network Services
- Conway Medical Center
-
Conway, SC
OTHER
- Position Summary: The Licensed Practical Nurse-PNS (LPN) is responsible for direct nursing care of assigned patients under the supervision of a registered nurse or physician in patient care area. The ...
- 6 Days Ago
Network Specialist (FT)
- Royalty Staffing
-
Charleston, SC
FULL_TIME
- Job Details: Maintain, secure and manage existing enterprise-wide network infrastructure both on-prem and on-cloud.Contribute to the design of the future global network and its implementation.Contribu...
- 15 Days Ago
IT SPECIALIST (NETWORK/SYSADMIN)
- Army National Guard Units
-
Eastover, SC
FULL_TIME
- This is a National Guard Title 32 Excepted position for a IT SPECIALIST (NETWORK/SYSADMIN), Position Description Number PDD2727000 , and is part of the SC DOL, South Carolina Army National Guard.
- 4 Days Ago
Provider Network Specialist jobs at Popular Companies
Network Engineer
- General Dynamics Information Technology
-
- Please take this opportunity to join one of GDIT's fastest long-standing growing programs! US Battlefield Information Co...
- 4/19/2024 12:00:00 AM
Network Engineer
- General Dynamics Information Technology
-
Camp Smith, HI
- Please take this opportunity to join one of GDIT's fastest long-standing growing programs! US Battlefield Information Co...
- 4/18/2024 12:00:00 AM
Network Engineer & Network Administrator
- Robert Half
-
Torrance, CA
- Two Network Roles: Network Engineer / Network Admin Location: South Bay (On-site with 40% travel) Target Salary: $100,00...
- 4/16/2024 12:00:00 AM
Network Engineer
- Leidos
-
Undisclosed, MD
- Description Join a long-term prime program with new positions and strong leadership. The Cyber & Analytics Solutions tea...
- 4/5/2024 12:00:00 AM
Network Engineer
- Leidos
-
Reston, VA
- Description Join us at Leidos, where your most important work is ahead! You will enjoy great benefits such as paid time ...
- 4/3/2024 12:00:00 AM
Network Engineer
- Leidos
-
Annapolis Junction, MD
- Description Leidos is looking for a Mid-Senior Level Network Engineer to join a high performing agile team using the Sca...
- 3/13/2024 12:00:00 AM
Network Engineer
- Leidos
-
Fort Meade, MD
- Description Are you ready to make an impact and join a creative, forward-thinking team? We’re looking for innovators and...
- 3/7/2024 12:00:00 AM
Network Engineer
- Leidos
-
Columbia, MD
- Description Provides assistance in all aspects of network management from network design through implementation, mainten...
- 2/6/2024 12:00:00 AM
About South Carolina
South Carolina (/ˌkærəˈlaɪnə/ (listen)) is a state in the Southeastern United States and the easternmost of the Deep South. It is bordered to the north by North Carolina, to the southeast by the Atlantic Ocean, and to the southwest by Georgia across the Savannah River.
South Carolina became the eighth state to ratify the U.S. Constitution on May 23, 1788. South Carolina became the first state to vote in favor of secession from the Union on December 20, 1860. After the American Civil War, it was readmitted into the United States on June 25, 1868.
South Carolina is the 40th most extensive and 23...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Network Specialist jobs
$55,191 to $82,511
Most Popular Cities in South Carolina for Provider Network Specialist Jobs
What does a Provider Network Specialist do?
Provider Network Specialist in Anderson, IN
Creates, maintains, and ensures the integrity of the provider data in DHP’s multiple claims payments systems and provider interface programs.
January 07, 2020
Provider Network Specialist in Tucson, AZ
Identifies and works with the provider to address education needs relative to DHP’s new product lines/expansions, utilization management, claims submission, and back-end issues resolution requirements of each assigned provider’s contract.
January 12, 2020
The Provider Network Specialist will work closely with all facets of the business, primarily with Care Management, Claims and Business Development.
January 08, 2020
Provider Network Specialist in Oakland, CA
Build and maintain a successful working relationship with Integra Managed Care and network providers.
December 03, 2019