Managed Care Provider Relations Manager jobs in Racine, WI

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)

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RN Care Manager
  • Managed Health Services Wisconsin
  • Racine, WI FULL_TIME
  • You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. * We are currently offering a $5,000 sign-on bonus for this position * ** This hybrid remote role requires less than 50% travel in Milwaukee / Appleton area and candidates will have the flexibility to work remotely from their home the remaining time ** Position Purpose: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care. • Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options • Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes • Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients • Provide patient and provider education • Facilitate member access to community based services • Monitor referrals made to community based organizations, medical care and other services to support the members’ overall care management plan • Actively participate in integrated team care management rounds • Identify related risk management quality concerns and report these scenarios to the appropriate resources. • Case load will reflect heavier weighting of complex cases than Care Manager I, commensurate with experience • Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems • Direct care to participating network providers • Perform duties independently, demonstrating advanced understanding of complex care management principles. • Participate in case management committees and work on special projects related to case management as needed Education/Experience: Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred. 2 years of clinical nursing experience in a clinical, acute care, or community setting and 1 years of case management experience in a managed care setting. Knowledge of utilization management principles and healthcare managed care. Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs.Licenses/Certifications: Current state’s RN license and a valid driver's license Pay Range: $66,100.00 - $118,900.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

    About the Company:
    Managed Health Services Wisconsin



  • 1 Month Ago

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Care Manager II (RN) - Now Hiring
  • Managed Health Services WI
  • Kansasville, WI FULL_TIME
  • You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offeri...
  • 12 Days Ago

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Partner Relations
  • Tutera Senior Living & Health Care
  • Crystal, IL OTHER
  • Job Details Job Location: Crystal Pines - Crystal Lake, IL Salary Range: Undisclosed DescriptionPartner Relations Coordinator Crystal Pines Rehabilitation & Health Care Center – Crystal Lake, IL If yo...
  • 29 Days Ago

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Partner Relations Coordinator
  • Crystal Pines Rehabilitation & Health Care Center
  • Crystal, IL FULL_TIME
  • Partner Relations Coordinator Crystal Pines Rehabilitation & Health Care Center – Crystal Lake, IL If you want to work for a company that truly values and appreciates its employees, join Crystal Pines...
  • 1 Month Ago

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Hearing Care Provider or AUD
  • HearingLife
  • Racine, WI OTHER
  • Overview Who WE Are: HearingLife is a national hearing care company and part of the Demant Group, a global leader in hearing healthcare built on a heritage of care, health and innovation since 1904. H...
  • 1 Month Ago

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Care Manager
  • Community Care, Inc.
  • Kenosha, WI FULL_TIME
  • Community Care is hiring a Case Manager/Care Manager to join our Family Care Program Team. This rewarding opportunity is perfect for someone who enjoys team collaboration, community case management, a...
  • 1 Day Ago

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0 Managed Care Provider Relations Manager jobs found in Racine, WI area

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Senior Vice President, Relationship Management
  • Careerbuilder
  • Pewaukee, WI
  • Bring your ideas. Make history. BNY Mellon offers an exciting array of future-forward careers at the intersection of bus...
  • 4/29/2024 12:00:00 AM

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TRAVEL NURSE RN - CATH LAB - $2,402 PER WEEK IN RACINE, WI
  • Mindlance Health
  • Racine, WI
  • Most of our positions require at least 2 years of nursing experience, with an active RN license and BLS and/or ACLS (if ...
  • 4/29/2024 12:00:00 AM

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TRAVEL NURSE RN - MED/SURG - $2,002 PER WEEK IN RACINE, WI
  • Mindlance Health
  • Racine, WI
  • Most of our positions require at least 2 years of nursing experience, with an active RN license and BLS and/or ACLS (if ...
  • 4/29/2024 12:00:00 AM

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Procurement Associate Manager
  • US Tech Solutions
  • Racine, WI
  • Duration: 06 Months Contract, Full-Time Employment Type: W-2 Job Description: · To support North America (NA) Global Con...
  • 4/28/2024 12:00:00 AM

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Auto Customer Relations Manager, $60,000 Plus!
  • City Auto Group
  • Milwaukee, WI
  • 19100 W. Capitol Dr., Brookfield, WI 53045 Customer Service/Relations Manager Experience is Required, From $60,000/Year!...
  • 4/27/2024 12:00:00 AM

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Pharmacy Relationship Manager
  • America's Pharmacy Group, LLC
  • Milwaukee, WI
  • Whether you are working in a Pharmacy looking for additional income, an established healthcare sales professional, or lo...
  • 4/27/2024 12:00:00 AM

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Senior Procurement Consultant
  • Robert Half
  • Buffalo Grove, IL
  • Our client in the north suburbs of Chicago has an immediate need for a strong Procurement Category Manager. This Leader ...
  • 4/27/2024 12:00:00 AM

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Relationship Manager AVP/VP/SVP
  • Associated Banc-Corporation
  • Milwaukee, WI
  • Guided by our relentless focus on people and desire to actively listen, we strive to create an inclusive culture and uph...
  • 4/26/2024 12:00:00 AM

Racine (/rəˈsiːn/ rə-SEEN) is a city in and the county seat of Racine County, Wisconsin, United States. It is located on the shore of Lake Michigan at the mouth of the Root River. Racine is located 22 miles south of Milwaukee. As of the 2010 U.S. census, the city had a population of 78,860, making it the fifth-largest city in Wisconsin. Its median home price of $103,625 makes it one of the most affordable cities in Wisconsin to buy a home. In January 2017, it was rated "the most affordable place to live in the world" by the Demographia International Housing Affordability survey. Racine is th...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Provider Relations Manager jobs
$98,498 to $142,088
Racine, Wisconsin area prices
were up 1.8% from a year ago

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