Top Provider Network Executive jobs in Idaho

Top Provider Network Executive plans and directs all aspects of an organization's provider network function. Responsible for developing the network and negotiating and administering contracts. Being a Top Provider Network Executive oversees provider relations and monitors and directs all provider services. Requires a bachelor's degree. Additionally, Top Provider Network Executive typically reports to a top management. The Top Provider Network Executive manages a departmental function within a broader corporate function. Develops major goals to support broad functional objectives. Approves policies developed within various sub-functions and departments. To be a Top Provider Network Executive typically requires 8+ years of managerial experience. Comprehensive knowledge of the overall departmental function. (Copyright 2024 Salary.com)

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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

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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

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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

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Canine Kennel Technician
  • Tip Top K9 Meridian
  • Nampa, ID FULL_TIME
  • Canine Kennel Technician - Part-Time to startWe love dogs! Do you?Do you love dogs and want a job in the dog industry? If the answer is yes, then the award-winning Tip Top K9 dog training team might b...
  • 23 Days Ago

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Professional Mover / Junk Removal Specialist
  • Top Shelf Storage
  • Boise, ID FULL_TIME
  • Company: Top Shelf Storage and Junk RemovalJob overview: For additional job details and to apply, please email apply@topshelfstorage.com with “Top Shelf Job Details” in the subject line.Salary$18/hr d...
  • 3 Days Ago

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Janitor / Housekeeper / Cleaner
  • Top Notch Cleaning
  • Dalton Gardens, ID PART_TIME
  • $17 Per hour for EVENING Commercial Cleaning. We are a small commercial cleaning company that is looking for part-time evening help. Commercial cleaning experience is helpful, but not necessary and we...
  • 9 Days Ago

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Sales Executive- Employee Benefits
  • AssuredPartners, Inc.
  • Cranford, NJ
  • Please note that the duties below can vary based on the workflow of your local office. Prospect: involves using our Sale...
  • 3/28/2024 12:00:00 AM

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Sales Executive - Employee Benefits
  • Brown & Brown, Inc.
  • Irvine, CA
  • Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best...
  • 3/28/2024 12:00:00 AM

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Sales Executive- Employee Benefits
  • AssuredPartners
  • Deerfield Beach, FL
  • Overview: Love what you do but not where you do it? As a Sales Executive at AssuredPartners, you will use your existing ...
  • 3/28/2024 12:00:00 AM

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Sales Executive- Employee Benefits
  • Assured Partners
  • Houston, TX
  • Overview Love what you do but not where you do it? As a Sales Executive at AssuredPartners, you will use your existing s...
  • 3/28/2024 12:00:00 AM

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Sales Executive, Employee Benefits
  • Keenan
  • Greater Los Angeles, CA
  • Keenan has an exciting career opportunity as a Sales Executive that will be tasked with the generation of new business i...
  • 3/27/2024 12:00:00 AM

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Sales Executive- Employee Benefits
  • Assured Partners
  • Deerfield Beach, FL
  • Overview Love what you do but not where you do it? As a Sales Executive at AssuredPartners, you will use your existing s...
  • 3/25/2024 12:00:00 AM

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Account Executive-Employee Benefits
  • National Financial Partners Corp.
  • Palm Beach Gardens, FL
  • Who We Are NFP is a seven-time Best Places to Work award winner in Business Insurance who has also earned the 5-Star Div...
  • 3/25/2024 12:00:00 AM

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Sales Executive- Employee Benefits
  • AssuredPartners, Inc.
  • Deerfield Beach, FL
  • The Sales Executive is a new Producer or a Producer that does not have a book of business. In this role, the Sales Execu...
  • 3/25/2024 12:00:00 AM

Idaho (/ˈaɪdəhoʊ/ (listen)) is a state in the northwestern region of the United States. It borders the state of Montana to the east and northeast, Wyoming to the east, Nevada and Utah to the south, and Washington and Oregon to the west. To the north, it shares a small portion of the Canadian border with the province of British Columbia. With a population of approximately 1.7 million and an area of 83,569 square miles (216,440 km2), Idaho is the 14th largest, the 12th least populous and the 7th least densely populated of the 50 U.S. states. The state's capital and largest city is Boise. Idaho p...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Top Provider Network Executive jobs
$366,750 to $679,141