Managed Care Provider Relations Manager develops, manages, and sustains relationship with members of physician network of managed care service providers. Recruits new physicians and manages the credentialing and orientation process. Being a Managed Care Provider Relations Manager serves as a resource for physicians, answering questions and providing information about network procedures or contracts. Monitors provider performance and resolves any issues. Additionally, Managed Care Provider Relations Manager reviews billings and claims payments according to managed care contracts. Requires a bachelor's degree. Typically reports to the head of a unit/department. The Managed Care Provider Relations Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Managed Care Provider Relations Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)
Position Title: Provider Relations Representative
Department: Network Management
Level: Non-Supervisory
Reports To: Director of Network Management
Position's Access to Private Health Information (PHI): Requires access to PHI, including “read only” access to eligibility, claims, and authorizations. “Write” access to member notes and provider notes.
Job Classification: Non-Exempt
Job Type: Full-Time
Pay Rate: $27.89 - $35.27/hr. Salary is based on qualifications and experience.
Position Summary:
Primary liaison between the client and MSO for the delivery of Managed Care Administrative Services. Responsible for concise and complete explanations of all phases of services from each MSO Department to the assigned IPA groups and resolving issues between them.
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Licensure/Certification: N/A
Location: Mira Mesa, San Diego
Date Posted: 04.02.2024
To apply for this position, complete the employment application following the link below and submit it to jobs@scpmcs.org
Job Type: Full-time
Pay: $27.89 - $35.27 per hour
Expected hours: 40 per week
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Work Location: Hybrid remote in San Diego, CA 92121
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