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Minimum Qualifications Bachelor’s degree, preferably in health care administration, and a minimum of 5 years experience in healthcare, plan or provider operations/administration/ relations or related area.
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Director of Provider Relations. Palmdale Regional Medical Center is a part of Southwest Healthcare, which is comprised of five acute care hospitals and several non-hospital access points, including: Corona Regional Medical Center, Palmdale Regional Medical Center, Southwest Healthcare Rancho Springs Hospital, Southwest Healthcare Inland Valley Hospital and Temecula Valley Hospital, Temecula Valley Day Surgery, A+ Urgent Care Centers, and Riverside Medical Clinics.
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Participates in public relations and marketing projects/programs for post acute services and promotes post-acute care services referral network in community hospitals and other healthcare organizations.
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The role of the Surgical Sales Director, Physician and Provider Relations (Sales), is responsible for developing and retaining customer relationships to drive business growth for key hospital surgical service lines.
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Collaborate with Vice President of Compliance and other compliance professionals who oversee compliance related to financial screening, eligibility and enrollment, provider credentialing and payment operations, vendor relations, service delivery contract performance management, benefit design, data privacy and security, medical case management and clinical services.
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Performs employee-focused functions related to recruiting, on- boarding/orientation, employee relations, benefits, training & development, leave management, compensation, performance management, employee engagement, and occupational health and safety, as guided by company policy and procedures and as delegated by the VP of Human Resources.
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The Provider Performance Manager is a key member of a cross-functional, collaborative organization (which includes Market Provider Performance, Sales, Health Services, Clinical, Stars & Risk Adjustment, Finance, Marketing, Cross-Segment Contracting, Provider Relations, and Network Development & Solutions.
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Three years job experience in provider relations for a managed care health plan or related healthcare environment preferred. Under general guidance from the Provider Services Manager, the Provider Relations Representative III is responsible for building long-term relationships with physicians, physician groups, ancillary and behavioral health providers and their staff in a positive and proactive manner in order to support their understanding and compliance with Alliance contracts, policies, and procedures.
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Work Experience: At least 7 years in healthcare and 3 years in provider contracting, provider relations, or provider network operations required. Manage provider relations activities including workshops, provider transactional support, responsiveness to provider inquiries, strategic activity deployment, including EHR access, 5-star enhancements, clinical enhancement deployment (MyCare visits), medical record access, transactional efficiency, provider communications, policy deployment, Provider Manual activities, and other activities of key strategic importance between PacificSource and its external provider network.
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Skills/Attributes Required: 4+ years of healthcare/managed care experience, with a focus on provider relations and/or provider network management. Ideal Candidate Background: The ideal candidate should have a background in provider relations and/or provider network management within the healthcare industry.
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Possessing working experience in Payer or Provider operations (domain areas such as Medical Management, Population Health Management, Utilization Management, Provider Network Management, Value-Based Contracting, Provider Relations, Quality Improvement, Informatics, ACO operations, etc.
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Manage and direct ongoing assessment of business functions for numerous departments within the scope of NCQA standards (e.g., Provider Services, Utilization Management, Medical Management, Integrated Health Management Services, Customer Relations, etc.
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HCA Healthcare Co-Founder. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.
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Sante Health System provides numerous client services such as billing, claims processing, contracting, credentialing, finance, human resources, information services, marketing/communications, physician services, practice management, provider relations, quality improvement, and utilization management.
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Required: ACLS (within 3 months), BLS (AHA Healthcare Provider), PALS if supervise pediatric department. Preferred: PALS, CPR Instructor, refined public relations, verbal and writing expertise.
$87,261 - $107,798 a yearFull-timeExpandApply NowActive JobUpdated Yesterday
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