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Manager, Provider Relations

Company: MemorialCare Medical Foundation
Location: Fountain Valley
Posted on: March 16, 2020

Job Description:

Essential Functions and Responsibilities of the Job

  • Responsible for supervising the Provider Relations staff, and for developing and maintaining policies and procedures directly related to The Provider Relations department.
  • Handles all aspects of staff management, including but not limited to: interviewing, hiring, evaluations, and resolution of issues.
  • Oversees day to day operations including but not limited to the assignment and distribution of work.
  • Oversees staff training, and identifies the need for ongoing staff training, as well as the application of lean principles to ensure proficiency and competence amongst staff.
  • Creates, manages, and communicates reference guides, standard work, and policies and procedures directly related to Provider Relations staff.
  • Responsible for overseeing the Provider Relations staff is maintaining strong relationships with network providers and providing ongoing education and training with a high level of customer service in a timely manner.
  • Interacts with internal and external providers, health plans, hospitals and regulatory agencies to resolve provider relations issues.
  • Oversees and maintains network intranet and internet sites, Contracted Provider Manuals, communication pieces, directories, and rosters.
  • Ensures the timely preparation of budgets, reports, and provider satisfaction surveys.
  • Assists and supports the Director in budget preparation and department compliance with budget.
  • Oversees Health Plan Adds, Changes, and Terminations, and the maintenance of provider demographic information listed with the health plans.
  • Responsible for the timely processing of check requests and approving check requests as needed for staff.
  • Assists with problem solving and improvement of managed care portal including training, provisioning, workflow and functionality.
  • Problem solving of provider issues, health plan issues, and billing issues as they relate to health plan submissions.
  • Perform any additional/miscellaneous duties (not inclusive to job description) as requested by the management within the scope of knowledge/ability.

    Essential Job


    • First line of contact for all interdepartmental requests related to provider relations issues.
    • Reports any dissatisfaction among providers, escalating concerns to management as appropriate, and resolves within limits of authority, reporting issue and resolution to the provider relations management team or supervisor.
    • Primary coordinator/trainer of portal implementation and responsible for increasing portal enrollment.
    • Serve as in-house PR rep, staffing provider relations line and assisting other departments in resolving provider issues.
    • Coordinates with customer service department to resolve provider issues.
    • "Other duties as assigned"


      • Minimum of 3-5 years relevant healthcare experience. Management experience required.
      • Bachelors degree or commensurate experience.
      • Strong verbal and written communication skills and the ability to interact effectively with a diverse group of staff, executives and providers.
      • Epic or equivalent Managed Care electronic medical record system and provider portal applications knowledge preferred.
      • Excellent computer skills and proficiency with Microsoft applications including Word, Power Point, Excel, and Outlook is a must.
      • Experience with Microsoft Access is also preferred.
      • Experience with various healthcare industry regulatory agencies and requirements including but not limited to CMS, NCQA, DMHC, ICE, DHCS, preferred.


        • High School Diploma or equivalent (Required)
        • Bachelor's Degree or equivalent (Preferred)

Keywords: MemorialCare Medical Foundation, Fountain Valley , Manager, Provider Relations, Executive , Fountain Valley, California

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