Provider Programs Manager jobs in the United States

Provider Programs Manager oversees the provider network administration function of an organization. Collects data, analyzes and reports on claims, utilization, costs and changes. Being a Provider Programs Manager reviews existing and future reimbursement policies, regulations and guidelines. Ensure competitiveness of provider network by the deployment of cost effective programs and systems that deliver results that meet cost control and quality goals of the organization. Additionally, Provider Programs Manager requires a bachelor's degree. Typically reports to a manager or head of a unit/department. The Provider Programs 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 Programs 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

Respiratory Case Manager – Disease Management Programs ( RN )
  • Northridge, CA FULL_TIME
  • We are looking to hire an experienced Respiratory Case Manager to join our clinical care team.

    Position Summary:

    This individual will be accountable for providing clinical care management and coordination support to high-risk members with pulmonary diagnoses/conditions in the North Region of Regal Medical Group .This position is embedded in a pulmonology clinic and supports members enrolled in Regal pulmonary disease management programs in order to reduce preventable healthcare utilization in the assigned population and improve health outcomes for members with chronic pulmonary illness.

    Responsibilities include providing direct patient assessments, care management, coordination of services, and triaging to appropriate clinical and non-clinical resources available to Regal members, including social and behavioral health resources. The Respiratory Care Manager will support the management of members identified across the continuum of care, including newly diagnosed individuals and those with recent hospitalizations, to the point of sustained clinical stabilization. There will be a strong focus on management of members with chronic obstructive pulmonary disease.

    Essential Duties and Responsibilities include the following:

    • Provides on-site clinical care, education, instruction, care management and coordination for Regal members seen in the designated pulmonology practice, specifically those enrolled in Regal pulmonary disease management programs and those with respiratory and respiratory-related equipment.
    • Assesses needs of Regal patients seen by designated pulmonologist and participates in development of treatment and care management plans.
    • Supports execution of plan of care for Regal members seen in the pulmonology clinic, with a special focus on patients enrolled in Regal pulmonary disease management programs.
    • Assist in consultation and counseling of members, caregivers and their families.
    • Support clinical interventions to assist member in regaining optimal functioning.
    • Works with Regal pharmacy staff to support members' medication management
    • Monitors effectiveness of interventions and communicates changes in plan of care as needed to help meet the needs of the member
    • Participates in interdisciplinary team discussions related to members served by Regal pulmonary disease management programs to support ongoing care management.
    • Collaborates with the Regal interdisciplinary care team to identify necessary resources needed in caring for the member.
    • Liaises with durable medical equipment vendors, as appropriate.
    • Acts as a resource to staff regarding best practices and care management of pulmonary patients.
    • Adheres to evidenced-based clinical guidelines
    • Appropriately documents all care provided in accordance with company and regulatory requirements.
    • Identifies and links members to appropriate follow-up for clinical and non-clinical supports and services within Regal North, including social and behavioral health services.
    • Adhere to group/health plan guidelines and protocols.
    • Other duties as assigned.

    The pay range for this position at commencement of employment is expected to be between $37.50 - $40.00 per hour for LVNs and $45.00 - $50.00 per hour for RNs; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

    The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

    Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

    If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

    As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

    Full Time Position Benefits:

    The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

    Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

    Health and Wellness:

    • Employer-paid comprehensive medical, pharmacy, and dental for employees
    • Vision insurance
    • Zero co-payments for employed physician office visits
    • Flexible Spending Account (FSA)
    • Employer-Paid Life Insurance
    • Employee Assistance Program (EAP)
    • Behavioral Health Services

    Savings and Retirement:

    • 401k Retirement Savings Plan
    • Income Protection Insurance

    Other Benefits:

    • Vacation Time
    • Company celebrations
    • Employee Assistance Program
    • Employee Referral Bonus
    • Tuition Reimbursement
    • License Renewal CEU Cost Reimbursement Program
    • Business-casual working environment
    • Sick days
    • Paid holidays
    • Mileage

    Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.


    Education and / or Experience:

    • Registered Nurse (RN) licensure in California or RCP with RRT Degree: AA/AS and
    • Registered Respiratory Therapist by The National Board of Respiratory Care (NBRC)
    • CPR/BLS card through the American Heart Association or the American Red Cross
    • Excellent customer service and communication skills
    • Experience with high-risk, complex patients
    • Experience delivering care in clinic setting
    • Ability to work independently in the field, while still meeting team deadlines and requirements
    • Proficient at Microsoft Office products
    • Bilingual in English /Spanish preferred
  • 27 Days Ago

Childcare Provider
  • Overview: In the GunHill Area of The Bronx We are seeking a dedicated Childcare Provider to join our team. The ideal candidate will have experience in daycare, early childhood education, or nannying, ...
  • 4 Days Ago

Program Manager, Customized Programs
  • Academic Programs International
  • Hills, TX FULL_TIME
  • Company DescriptionAcademic Programs International (API) is a leader in international and experiential education. Our mission is to design and deliver international experiences that inspire learning a...
  • 9 Days Ago

Manager II GBD Special Programs (Provider Audit)
  • The Elevance Health Companies, Inc.
  • Anticipated End Date: 2024-07-05 Position Title: Manager II GBD Special Programs (Provider Audit) Job Description: Location: Indianapolis, IN, Tampa FL, Grand Prairie TX, Nashville TN, Richmond VA Hou...
  • 3 Days Ago

Manager II GBD Special Programs (Provider Audit)
  • Elevance Health
  • Description Location: Indianapolis, IN, Tampa FL, Grand Prairie TX, Nashville TN, Richmond VA Hours: M – F Standard Working hours Travel: Hybrid (1-2 days onsite per week) Position Overview: The Manag...
  • 4 Days Ago

Part Time Advanced Practice Provider (NP or APRN)
  • BAART Programs
  • Berlin, VT PART_TIME
  • Description Part Time Nurse Practitioner - Berlin, VTBAART Treatment Centers are dedicated to providing individualized treatment integrating pharmacotherapy, clinical counseling, recovery support and ...
  • 7 Days Ago

ONR PMR-51 Senior Program Manager
  • International Systems M
  • Washington, DC
  • Job Description Job Description International Systems Management Corp (ISM) is seeking a qualified Senior Program Manage...
  • 6/16/2024 12:00:00 AM

Operations Manager
  • Orangetheory - Franchise #0308
  • Ashburn, VA
  • Benefits: 401(k) Competitive salary Flexible schedule Health insurance Paid time off Training & development Vision insur...
  • 6/16/2024 12:00:00 AM

Store Manager
  • Extra Space Storage
  • Ashburn, VA
  • As a Store Manager, you will have the opportunity to be part of a diverse team with an excellent company culture. We off...
  • 6/16/2024 12:00:00 AM

Program Manager
  • Alakaina Family of Companies
  • Bethesda, MD
  • The Alaka`ina Foundation Family of Companies (FOCs) has a potential need for a Program Manager to support a government c...
  • 6/14/2024 12:00:00 AM

Program Coordinator, Rural & Urban Programs
  • Columbia, MD
  • The Maryland Technology Development Corporation (TEDCO) is a quasi-government entity established by the Maryland General...
  • 6/14/2024 12:00:00 AM

PMO Lead - VA Digital Transformation Center - Remote
  • UnitedHealth Group
  • Washington, DC
  • Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. ...
  • 6/13/2024 12:00:00 AM

Technical Program Manager, Cloud Solutions (PMP, CSM) - Hybrid
  • VMD Corp
  • Washington, DC
  • Job Description Job Description About the Mission You Will Join: VMD is rapidly growing IT services company focused on t...
  • 6/12/2024 12:00:00 AM

Program Control Team Manager
  • SAIC
  • Reston, VA
  • Description Is meaningful work important to you? Be part of a team that makes a difference! Join SAIC with employee's wo...
  • 6/12/2024 12:00:00 AM

Income Estimation for Provider Programs Manager jobs
$106,963 to $138,168