Managed Care Provider Relations Manager jobs in Florida

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)

P
Account Manager,Managed Care
  • Pediatric Associates Family of Companies
  • Plantation, FL CONTRACTOR
  • Summary

    Pediatric Associates was founded in Hollywood, FL in 1955. The same clinician-led, evidence-based, medical home passion is a unifying driver for those who join Pediatric Associates Family of Companies. The Pediatric Associates Family of Companies is a growing team of Pediatricians and Pediatric Care Teammates who are excited to be part of the first nationwide Pediatric Primary Care Medical Home. We further our uniqueness by ensuring the clinician voice is leading our medical home innovations.

    Remote Opporutnity

    Primary Functions

    • Develops and maintains strong payor relationships, serves as primary point of contact and payor liaison. Maintains an understanding of contractual arrangements.
    • Ensures all payor issues are addressed at monthly/quarterly meetings.
    • Resolves and responds to payor communications/requests, addresses payor issues including member complaints, and evaluates and resolves payor compliance issues.
    • Responsible for payor operations including maintaining contract data bases and fee schedule.
    • Monitors, tracks, and evaluates incentive programs and assists in the resolution of program performance and payment issues.
    • Researches, escalates, and addresses contract loading and payment issues involving Capitation, Gainshare/Risk, Pay for Performance, and other Incentive arrangements.
    • Supports growth initiatives by conducting due diligence, managing the payor notification process, and ensuring timely loading and issue resolution for all acquisitions.
    • Maintains tracking tools/systems, and processes for contract implementation, evaluation, and ongoing performance.
    • Maintains a system of communication to collaborate with internal departments and management.
    • Identifies payor trends and anticipate issues which may impact the organization.

    Qualifications

    EDUCATION: Minimum Bachelor’s Degree required. Associates Degree plus minimum of 5 years related experience may substitute for Bachelor’s Degree requirement.

    EXPERIENCE: Minimum 3 years of Managed Care or Healthcare experience required including experience with payors and large groups.

    Knowledge, Skills And Abilities

    • Managed Care and provider relations experience and knowledge
    • Knowledge of Medicaid, payor reimbursement methodologies, and Value Based Care
    • Ability to analyze and interpret financial data
    • Knowledge of credentialing and claims processes
    • Advanced Microsoft Office skills
    • Excellent oral and written communication skills
    • Strong interpersonal skills
    • Effective planning and organizational skills, critical thinker and action oriented

    TYPICAL WORKING CONDITIONS

    • Non-patient facing
    • May be either full time remote/telework or rotate working in the office and remote/telework
    • If remote, this job must be U.S. based
    • Indoor Work
    • Operating Computer
    • Reach Outward; Reach above shoulder
    • Standing; Sitting; Traveling
    • Walking; Bending
    • Ability to wear Personal Protective Equipment (PPE)

    Other Physical Requirements

    • Vision
    • Sense of sound
    • Sense of touch
    • Manual dexterity

    Performance Requirements

    Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI (Protected Health Information) in accordance with organizational policy, Federal, State, and local regulations.

    The Pediatric Associates Family of Companies an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
  • Just Posted

M
MANAGED CARE CONTRACT MANAGER
  • Moffitt Cancer Center Careers
  • Tampa, FL FULL_TIME
  • At Moffitt Cancer Center, we strive to be the leader in understanding the complexity of cancer and applying these insights to contribute to the prevention and cure of cancer. Our diverse team of over ...
  • Just Posted

L
Provider Relations Manager (9613)
  • Lutheran Services Florida
  • Jacksonville, FL FULL_TIME
  • Lutheran Services Florida (LSF) envisions a world where children are safe, families are strong and communities are vibrant. LSF is looking for a talented Provider Relations Manager who would like to m...
  • 12 Days Ago

I
Manager, Provider Relations (CIDD)
  • Independent Living Systems
  • Miami, FL FULL_TIME
  • About UsJoin us in making a career in Independent Living Systems, an industry leader in managing home and community-based programs for over 20 years. Independent Living Systems, LLC and its subsidiari...
  • 16 Days Ago

C
Area Sales Manager - Acute Care
  • Careers -Area Sales Manager
  • Lauderdale, FL FULL_TIME
  • Area Sales Manager - Acute Care Apply Now Description/Job Summary Area Sales Manager – Acute Care & Clinical Nursing SalesOverview of the RoleThe Acute Care & Clinical Nursing Area Sales Manager will ...
  • 7 Days Ago

A
Managed Care Manager - RN (Case Manager)
  • Agape Network
  • Miami, FL FULL_TIME
  • Job DescriptionManaged Care Manager - RNWho we are:Since 1981 we have been transforming the life of thousands. We are looking to continue helping more members of our community. We are now expanding an...
  • 1 Day Ago

A
Relationship Manager
  • Ascensus
  • Greensboro, NC
  • Newport, an Ascensus company, helps employers offer their associates a more secure financial future through retirement p...
  • 6/11/2024 12:00:00 AM

G
Relationship Manager
  • GROVER GAMING
  • Elyria, OH
  • Job Description Job Description Job Title: Relationship Manager Department: Ohio Sales Reports To: Sales Manager Status:...
  • 6/11/2024 12:00:00 AM

A
Relationship Manager
  • Allium Financial Advisors, LLC
  • Lake Oswego, OR
  • Summary This position is responsible for partnering with Financial Advisors to help manage client relationships by perfo...
  • 6/10/2024 12:00:00 AM

F
Relationship Manager
  • Flourish
  • New York, NY
  • Flourish was founded in 2017 with the goal of helping financial advisors to better secure the financial futures of their...
  • 6/9/2024 12:00:00 AM

W
Relationship Manager
  • Wind River Payments
  • Madison, WI
  • As a Relationship Manager at Wind River Payments (WRP), you will thrive on building strong, long-term client relationshi...
  • 6/9/2024 12:00:00 AM

P
Relationship Manager
  • Palmetto
  • Company Description Recognized by Forbes as one of the fastest-growing private companies in the United States, Palmetto ...
  • 6/7/2024 12:00:00 AM

V
Relationship Manager
  • Valley Bank
  • Jacksonville, FL
  • Why you should consider applying to this opportunity: You're excited to build relationships with Commercial & Industrial...
  • 6/7/2024 12:00:00 AM

T
Relationship Manager
  • Team Select Home Care
  • Evansville, IN
  • Overview: You can apply by texting TSC to 97211 Now offering DailyPay! Ask us about it! Are you looking for an exciting ...
  • 6/7/2024 12:00:00 AM

Florida (/ˈflɒrɪdə/ (listen); Spanish for "land of flowers") is the southernmost contiguous state in the United States. The state is bordered to the west by the Gulf of Mexico, to the northwest by Alabama, to the north by Georgia, to the east by the Atlantic Ocean, and to the south by the Straits of Florida. Florida is the 22nd-most extensive (65,755 sq mi or 170,300 km2), the 3rd-most populous (21,312,211 inhabitants), and the 8th-most densely populated (384.3/sq mi or 148.4/km2) of the U.S. states. Jacksonville is the most populous municipality in the state and the largest city by area in th...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Provider Relations Manager jobs
$96,284 to $138,893

Managed Care Provider Relations Manager in Trenton, NJ
Rizk says McKesson has created a collegial relationship by reaching out to providers.
January 03, 2020
Managed Care Provider Relations Manager in Gary, IN
Aetna (57% favorable/37% unfavorable) has turned around providers by changing leadership and addressing provider concerns.
February 24, 2020
Managed Care Provider Relations Manager in Birmingham, AL
Providers "want legitimate, honest P4P programs, data exchange, streamlined business processes, and clarity.
November 28, 2019