Managed Care Provider Relations Manager jobs in Pennsylvania

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)

M
MOMobile Managed Care Program Manager
  • Maternity Care Coalition
  • Philadelphia, PA FULL_TIME
  • Organizational Summary

    In 1980, a group of Philadelphia health and social justice activists came together over concerns about the well-being of pregnant people and infants. They created Maternity Care Coalition (MCC) and advocated for change with policymakers and decision makers.


    Today, we continue to center children and their families by supporting, referring, educating, researching, and advocating.


    Position Summary
    Responsible for day-to-day operations of the MOMobile Managed Care program. Provides leadership in conducting outreach, follow-up, and home visiting to identify pregnant women and families with young children and provide appropriate services.

    Benefits include:
    • Three (3) weeks paid vacation, plus One (1) week paid Winter Break
    • Medical, Dental, Vision, Voluntary & Supplemental Life Insurance through CIGNA
    • Cafeteria Plan through Benefit Wallet: FSA and Commuter plans

    Essential Functions

    • Manages and monitors all MOMobile Managed Care activities and ensures quality of services.
    • Provides supervision to managed care advocates and student intern(s).
    • Responsible for recruitment and hiring of managed care advocates.
    • Acts as a community liaison between MCC, clients, and Medicaid managed care organizations (MCOs) and manages referrals from MCO partners.
    • Routinely communicates with MCO providers and schedules monthly/bi-monthly check-in meetings.
    • Oversees the contract scope of services with MCO partners.
    • Prepares and submits all reports and invoices as required by funders.
    • Develops and monitors program budgets and spending.
    • Communicates and coordinates contract requirements with other MCC program managers.
    • Facilitates regular staff meetings and conducts individual supervisory meetings.
    • Conducts regular home visit observations.
    • Provides direct services to a small caseload when needed.
    • Regularly reviews client files and provides feedback to staff.
    • Prepares performance evaluations with input from staff.
    • Identifies staff training needs and writes yearly training plans.
    • May be required to travel the eight-county region

    Other Tasks

    • Adheres to the MCC’s security guidelines and ensures the appropriate handling of sensitive information.
    • Attends relevant staff meetings to promote communication and execution of goals.
    • Completes special projects specific to the function of the department or as needed for the department as directed by the supervisor.
    • Other duties as assigned within the scope of position expectations.

    Knowledge, Skills, and Abilities

    • Understanding of MCC’s mission, goals, and objectives and ability to work independently with a high level of energy and contribute as part of a larger team.
    • Knowledge of the concepts and practices associated with community health issues, particularly with pregnant women, prenatal care, parenting and other services for mothers, young children, and their families.
    • Ability to travel in and around the Greater Philadelphia region to conduct home visits and community outreach.
    • Knowledge of and sensitivity to issues facing the community served.
    • Experience in client management procedures for determining eligibility, assessing needs, identifying resources, making referrals, following up, and documenting client interactions.
    • Demonstrated clinical social work skills.
    • Strong interpersonal skills as demonstrated by compassionate, courteous, cordial, cooperative, and professional interaction with diverse groups of co-workers, community partners, clients, and members of the community.
    • Ability to operate a computer and use a variety of common software programs including Microsoft Office, spreadsheets, and customized databases.
    • Effective and accurate documentation of case notes and client data according to established client management documentation procedures.
    • Ability to organize tasks in an efficient manner and follow-up and follow-through with strong attention to detail.
    • Proficient with Microsoft Office Suite, ability to operate a computer and use a variety of common software programs a must
    • Experience utilizing virtual meeting platforms
    • This is a telecommuting position. Staff are required to be onsite at least (1) day a week (you can add your requirement). In addition, staff must establish a safe and supportive workspace at home.

    Experience, Education, and Licensure

    • Master’s degree in social work or related field strongly preferred; bachelor’s degree required.
    • 2 years of supervisory experience preferred
    • Valid driver’s license
  • 1 Month Ago

C
Hospice Provider Relations (Community Liaison) - Philadelphia County
  • Crossroads Hospice & Palliative Care
  • Philadelphia, PA FULL_TIME
  • The Provider Relations (Community Liaison) is a results-driven professional who supports the interdisciplinary hospice team by building relationships with doctors, facilities, and other healthcare org...
  • 25 Days Ago

N
Account Manager / Inside Sales - Managed IT Service Provider
  • Nellcom Technologies, LLC
  • Castle, PA FULL_TIME
  • The Account Manager’s primary responsibility is to manage clients and their business IT needs. As a part of this management, you will be responsible for being the business point of contact for the cli...
  • 8 Days Ago

O
PT Patient Care Advocate
  • Oakland Manager LLC
  • Bethlehem, PA FULL_TIME
  • We are excited to invite candidates to apply to our Bloc Dispensary in Bethlehem, PA! Our Team is seeking ambitious positive individuals who are like-minded in their commitment to cannabis, understand...
  • 10 Days Ago

O
Justice Grown Patient Care Advocate
  • Oakland Manager LLC
  • Dickson, PA FULL_TIME
  • SummaryThe Patient Care Associate(PCA) is responsible for delivering an exceptional customer experience. This role ensures all sales are compliant with state regulations and that customer needs are he...
  • 20 Days Ago

C
Hospice Provider Relations (Community Liaison) - Chester/Delaware County
  • Crossroads Hospice & Palliative Care
  • West Chester, PA FULL_TIME
  • The Provider Relations (Community Liaison) is a results-driven professional who supports the interdisciplinary hospice team by building relationships with doctors, facilities, and other healthcare org...
  • 23 Days Ago

I
Relationship Manager
  • Israel Discount Bank of New York
  • New York, NY
  • Company Description For more than 70 years, IDB Bank has made it our mission to be the best bank for our clients by putt...
  • 3/29/2024 12:00:00 AM

S
Relationship Manager
  • Sabal Trust Company
  • Tampa, FL
  • Job Description Job Description Position: Trust & Financial Services Associate: Sabal Trust Company, Florida's largest e...
  • 3/29/2024 12:00:00 AM

B
Relationship Manager
  • Brookstone Capital Management
  • Wheaton, IL
  • About Us: Brookstone Capital Management is a dynamic and forward-thinking national Financial Services firm with ~$9B in ...
  • 3/28/2024 12:00:00 AM

B
Relationship Manager
  • BHI
  • Miami, FL
  • Job Summary This positions primary responsibility is new business development and existing / new account management. Ori...
  • 3/28/2024 12:00:00 AM

C
Relationship Manager
  • Claire Myers Consulting
  • Wichita Falls, TX
  • Our client is a dynamic, boutique wealth management firm with a mission to educate the community on all things financial...
  • 3/28/2024 12:00:00 AM

O
Relationship Manager
  • OPENLANE
  • Fredericksburg, VA
  • Who We Are: At AFC (Automotive Finance Corporation) we fuel the entrepreneurial dream in our community. For more than 30...
  • 3/26/2024 12:00:00 AM

W
Relationship Manager
  • WaFd Bank
  • Medford, OR
  • Min: USD $85,000.00/Yr. Max: USD $130,000.00/Yr. Job Summary: A Relationship Manager is responsible for developing a bus...
  • 3/26/2024 12:00:00 AM

B
Relationship Manager
  • BSF
  • Walnut Creek, CA
  • POSITION OVERVIEW: The Relationship Manager is responsible for developing and managing client relationships with local b...
  • 3/26/2024 12:00:00 AM

Pennsylvania (/ˌpɛnsɪlˈveɪniə/ (listen) PEN-sil-VAY-nee-ə), officially the Commonwealth of Pennsylvania, is a state located in the northeastern and Mid-Atlantic regions of the United States. The Appalachian Mountains run through its middle. The Commonwealth is bordered by Delaware to the southeast, Maryland to the south, West Virginia to the southwest, Ohio to the west, Lake Erie and the Canadian province of Ontario to the northwest, New York to the north, and New Jersey to the east. Pennsylvania is the 33rd-largest state by area, and the 6th-most populous state according to the most recent of...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Provider Relations Manager jobs
$100,444 to $144,899

Managed Care Provider Relations Manager in Trenton, NJ
Rizk says McKesson has created a collegial relationship by reaching out to providers.
January 03, 2020
Managed Care Provider Relations Manager in Gary, IN
Aetna (57% favorable/37% unfavorable) has turned around providers by changing leadership and addressing provider concerns.
February 24, 2020
Managed Care Provider Relations Manager in Birmingham, AL
Providers "want legitimate, honest P4P programs, data exchange, streamlined business processes, and clarity.
November 28, 2019