Managed Care Provider Relations Manager jobs in Rhode Island

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)

M
Employee Relations investigations
  • Managed Staffing, Inc.
  • Woonsocket, RI FULL_TIME
  • Description

    Position Summary:

    Would you like to join CVS Health as part of our dynamic Human Resources team?

    As a Colleague Relations Investigator, you will work in a fast paced, high-volume environment. You are responsible for the ownership and execution of investigations into workplace complaints. You will utilize the CVS Colleague Relations Investigator Playbook to conduct these investigations. This will include a thorough review of all applicable CVS Policies and/or Procedures to assess for violations. You will evaluate for legal and financial risk to the company, collaborating with our legal partners when necessary. When appropriate, you will partner with other departments within the organization such as Risk Management, Loss Prevention, Security, and Compliance. At the conclusion of your investigations, you will provide investigative findings and recommendations to key stakeholders.

    This is an individual contributor role, you will not have people management responsibility.

    Duties & Responsibilities

    Investigate workplace complaints with a heavy focus on cases of alleged discrimination, retaliation, harassment, or a hostile work environment.

    Manage a caseload of multiple investigations, working both autonomously and collaboratively with other team members.

    Responsible for creating investigation plans, interviewing colleagues, reviewing CCTV footage, analyzing internal company documents such as payroll, corrective actions, expense reports and timecards.

    Responsible for drafting investigative findings and recommendations by applying knowledge of company policies, employment laws, and discrimination laws.

    Maintain a complete and thorough case log within our case management system, Salesforce.

    Consult on matters regarding company policies, procedures, and practices.

    Provide expert advice, guidance, and counsel to leaders on Colleague Relations issues as it relates to the investigations you are conducting.

    Collaborate with Colleague Relations peers, including ER Consultants and ER Advisors, to promote a positive culture with the company and to provide a positive experience to CVS Health colleagues.

    Required Qualifications

    5 years of Employee Relations investigations experience.

    Must be available to work an eight-hour workday time of day may fluctuate based on business need.

    Additional Details

    • Is this request for Peak Season? Select applicable value : _N/A - Not RAMP Related
    • Duties : See Description
    • Experience : See Description
    • Position Summary : See Description
    • Education : See Description
    • What days & hours will the person work in this position? List training hours, if different. : 8 hour workday. Time of day may fluctuate based on business need.
    • Type of Start : Individual starts
    • Program Office - Point Of Contact : Jennifer Sortor
    • Is this an in-person, patient-facing role? : No
    • Onsite Requirements : Fully remote (never coming onsite)

    Qualification Must Have CVS Caremark Requirements

    Prior CVS/Aetna work experience?

    No

    Verifyable High School Diploma or GED Required

    Yes Is this request for Peak Season? Select applicable value

    _N/A - Not RAMP Related

    Duties

    See Description

    Experience

    See Description

    Position Summary

    See Description

    Education

    See Description

    What days & hours will the person work in this position? List training hours, if different.

    8 hour workday. Time of day may fluctuate based on business need.

    Type of Start

    Individual starts

    Program Office - Point Of Contact

    Jennifer Sortor

    Is this an in-person, patient-facing role?

    No

    Onsite Requirements

    Fully remote (never coming onsite)
  • 15 Days Ago

Q
Board Certified Behavioral Analyst - Master Trainer
  • QBS, provider of Safety-Care
  • Providence, RI FULL_TIME
  • Safety-Care Master Trainer (BCBA)***Must be able to travel 60% or more overnight in any given workweek, 2-3 weeks a month.***Must be a Board-Certified Behavior Analyst (BCBA)***Must live within 60 min...
  • 4 Days Ago

C
Outpatient Managed Care Coordinator Per Diem
  • Care New England
  • Providence, RI PER_DIEM
  • Responsibilities: Patient Benefit Verification Information: Ensures accurate completion of benefit verification of all new patient insurance information and authorization in accordance with State and ...
  • 25 Days Ago

K
Primary Care NP (Job )
  • KPG Provider Services
  • Smithfield, RI FULL_TIME
  • Outpatient Facility: Looking for an experienced Primary Care NP in the Smithfield, Rhode Island area. Below you will find the Position Overview with all the detail regarding the position. Position Ove...
  • 2 Days Ago

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Marketing Project Manager
  • Managed Staffing, Inc.
  • Woonsocket, RI CONTRACTOR
  • Portfolio & Delivery Management (PDM) is responsible for building and sustaining enhanced capabilities that support efficient management and execution of the Enterprise Marketing portfolio. PDM drives...
  • 2 Days Ago

M
Nurse Case Manager II
  • Managed Staffing, Inc.
  • Woonsocket, RI FULL_TIME
  • Description Location: "We service in Wayne, Macomb, and Kalamazoo Counties in MI".Case Management Certification/CCM is REQUIREDThe Registered Nurse Case Manager utilizes a collaborative process of ass...
  • 7 Days Ago

Rhode Island (/ˌroʊd -/ (listen)), officially the State of Rhode Island and Providence Plantations, is a state in the New England region of the United States. It is the smallest state in area, the seventh least populous, the second most densely populated, and it has the longest official name of any state. Rhode Island is bordered by Connecticut to the west, Massachusetts to the north and east, and the Atlantic Ocean to the south via Rhode Island Sound and Block Island Sound. It also shares a small maritime border with New York. Providence is the state capital and most populous city in Rhode Is...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Provider Relations Manager jobs
$105,811 to $152,636

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