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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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Possessing working experience with Population Health Management technologies and approaches (e.g., high-risk user stratification tools, cost/quality/utilization trend analysis, provider performance tools.
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Possessing experience in project management and product development life cycle management specifically in healthcare product design and development to support care management and delivery workflows.
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To help us achieve this we have the PwC Professional; our global leadership development framework. Possessing working knowledge and experience in software development, implementation, and optimization to accurately translate clinical and business requirements into engineering design documents and instructions.
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Minimum of one (1) year of experience in provider network development and/or provider network management capacity, account management, or provider relations experience in a managed care organization required.
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Coach others, recognise their strengths, and encourage them to take ownership of their personal development. Possessing working experience in Clinical Analytics, Medical Economics, and/or Population Health Analytics or working in collaboration with related functions.
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Lead and coordinate all provider relations activities, including education, reporting, and network development. This position exists to manage the provider network, which includes the administrative, provider education and provider resolution functions related to the provider network; manage the Provider Relation Representatives who act as a liaison between contracted payers, providers and ancillary providers to promote superior customer service in the area of Provider Relations.
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Molina Health Plan Network Provider Relations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations.
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Provider Relations staff are the primary point of contact between Molina Healthcare and contracted provider network. Develops and deploys strategic network planning tools to drive Provider Relations and Contracting Strategy across the enterprise.
Starting at $54,373.27 - $117,808.76 a year depends on education, experienceFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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As part of our Network Strategy Provider Relations team, you will be responsible for assisting with the development and maintenance of the Provider Network and the related Pharmacy Service contracts and Agreements.
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Responsible for providing strategic leadership for provider engagement and contracting for assigned state with a benefit spend between $3 billion and $8 billion, including local cost of care and trend management, provider contracting, implementation, and local oversight of all types of payment innovation programs, and provider relations and education.
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As a member of the Network Strategy and Enablement team, the Network Training and Quality Assurance Manager will be responsible for designing and building training and quality programs to support Recruiting, Provider Relations, and Provider Operations ensuring consistent adherence to network best practices, and monitoring the quality of interactions Network Development colleagues are having with providers.
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10+ years of experience in managed care network development and provider relations/contracting management in a health care and/or managed care environment. For Carolina Complete Health plan: At least five (5) years of combined network operations, provider relations, and management experience; must reside in NC.Pay Range: $162,200.00 - $308,000.00 per yearCentene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.
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EXPERIENCEMinimum five (5) years' health plan or provider experience in Provider Relations such as provider relations, provider contracting, network management, healthcare analytics, risk and/or value based contracting, office manager/administrator or other equivalent experience.
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Bachelor's Degree or equivalent provider contract, network development and management, or project management experience in a managed healthcare setting. It is an external-facing, field-based position requiring an in-depth knowledge of provider relations and contracting subject matter expertise to successfully engage high priority providers, including senior leaders and physicians, to ensure provider satisfaction, education on key Molina initiatives, and improved coordination and partnership.
Starting at $44,936.59 - $97,362.61 a year depends on education, experienceFull-timeExpandApply NowActive JobUpdated Today
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