Provider Contracting Manager manages the activities of the contracting staff that prepare and maintain contracts and the contracts database system for a health plan network. Responsible for negotiating with facilities joining the health network and setting rates. Being a Provider Contracting Manager oversees network reporting requirements to ensure compliance with regulatory agencies, and to produce accurate and relevant reporting of data. Trains and develops staff. Additionally, Provider Contracting Manager requires a bachelor's degree. Typically reports to a head of a unit/department. The Provider Contracting 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 Provider Contracting 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 Description: Medical Review Nurse (MRN)
Reporting to the Medical Review Manager, the Medical Review Nurse (MRN) will provide professional assessment, planning, coordination, implementation and reporting of complex clinical data and support the medical review operations of Provider Resources, Inc (PRI). The MRN position will perform comprehensive medical record and claim reviews from the Medicare fee-for-service program to make utilization and quality of care determinations based on applicable Medicare coverage policies, coding rules and guide lines, evidence-based standards of care and utilization and practice guidelines.
Responsibilities:
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0 Provider Contracting Manager jobs found in Cranston, RI area