FountainValleyRecruiter Since 2001
the smart solution for Fountain Valley jobs

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

    Outcomes

    • 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"



      Experience


      • 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.

        Education


        • 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

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Executive Jobs


Shift Supervisor Management Trainee
Description: Job DescriptionThe Shift Supervisor Trainee role is an entry-level, short-term role that prepares an employee to perform a higher-level supervisory role, such as Operations Supervisor or Shift Supervisor. (more...)
Company: CVS Health
Location: Santee
Posted on: 04/10/2020

Home Care Manager
Description: The Home Care Supervisor oversees coordination and administration of all aspects of our Home Visit Program. This includes oversight of scheduling, staffing and leading the Home Visit Program. br Leadership: (more...)
Company: Wider Circle
Location: Lynwood
Posted on: 04/10/2020

Senior Manager, Contract Manufacturing
Description: The purpose of this position is to develop and direct the strategic and tactical CMO and CRO management activities required to support the pharmaceutical and development business. This position assumes (more...)
Company: Avanir Pharmaceuticals
Location: Aliso Viejo
Posted on: 04/10/2020


Director, Product Management - Subscriber Lifecycle
Description: Hulu is the leading premium streaming service offering live and on-demand TV and movies, with and without commercials, both in and outside the home. Operating at the intersection of entertainment and (more...)
Company: Hulu
Location: Santa Monica
Posted on: 04/10/2020

Manager Test Engineering 1
Description: At Northrop Grumman, our employees have incredible opportunities to work on revolutionary systems in air and space that impact people's lives around the world today, and for generations to come. Our work (more...)
Company: Northrop Grumman
Location: Redondo Beach
Posted on: 04/10/2020

Maintenance Manager
Description: Job Type: Exempt br State::CA City:Camarillo br Brand:Avalon br br Overview AvalonBay is proud to be named one of Glassdoor's Best Places to Work in 2019. br br Creating a better way to liveis (more...)
Company: Avalonbay Communities
Location: Camarillo
Posted on: 04/10/2020

Real Estate Manager
Description: RESPONSIBILITIES Manages all aspects of a single property or portfolio of commercial, industrial or retail properties. Oversees all marketing, operations and financial activities.ESSENTIAL DUTIES AND (more...)
Company: CBRE
Location: Newport Beach
Posted on: 04/10/2020

IT Manager, Desktop Engineering
Description: The IT Manager, Desktop Engineering ensures end-user satisfaction throughout the organization by managing the development and delivery of technical solutions in support of the end-user computing EUC (more...)
Company: Avanir Pharmaceuticals
Location: Aliso Viejo
Posted on: 04/10/2020

Clinical Manager, RN - Focus Home Health Stockton, $10K Sign - on
Description: US Job ID: 2020-20210 Job Code: 4434 Facility: West Region Category: Nursing Overview Covenant Care encompasses three business lines that are an integral part of a patient's continuum of care and
Company: Covenant Care California
Location: Aliso Viejo
Posted on: 04/10/2020

Home Care Manager
Description: The Home Care Supervisor oversees coordination and administration of all aspects of our Home Visit Program. This includes oversight of scheduling, staffing and leading the Home Visit Program. br Leadership: (more...)
Company: Wider Circle
Location: Buena Park
Posted on: 04/10/2020

Log In or Create An Account

Get the latest California jobs by following @recnetCA on Twitter!

Fountain Valley RSS job feeds