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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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This includes all functions and systems supporting provider relations, provider communication, network capacity, appointment accessibility and provider satisfaction for the Health Plan. The director of Provider Relations plays an integral role in setting cross-functional alternative payment model strategies, supporting innovative service delivery methods including telehealth and ensuring accurately functioning provider processes across the provider lifecycle.
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10+ years of experience in contract negotiation, network development and provider relations. Minimum of 10 years progressively responsible related experience in contract negotiation, network development and provider relations strongly preferred.
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Also responsible for the optimization and integration of these areas: member services, network management, provider and member relations, marketing, training/development, resource management, as it may relate to this product line.
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Minimum 5 years in a progressive management position with a focus on program development, provider relations, marketing or in an Operations Specialist position. The McLaren system includes 13 hospitals in Michigan, ambulatory surgery centers, imaging centers, a primary and specialty care physician network, commercial and Medicaid HMOs, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network and a wholly owned medical malpractice insurance company.
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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.
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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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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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Participate in standing meetings as necessary, including but not limited to, provider relations, contracting, network development and team building. Under the general direction of the Supervisor, Provider Dispute Resolution Supervisor the Provider Dispute Resolution (PDR) Analyst will review, research, and resolve complex and involved provider disputes for contracted as well as non-contracted providers in accordance with state and federal guidelines.
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Provider network development. Founded by Brigham and Women’s Hospital and Massachusetts General Hospital, Mass General Brigham supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care and other health-related entities.
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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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BS/BA in business administration or related healthcare field and a minimum of 8 years of experience in healthcare operations, finance, underwriting, actuary, network development, and/or sales; or any combination of education and experience, which would provide an equivalent background.
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Directly assist intake and provider relations as necessary, including introductory calls, general qualification screening, documentation collection, benefit education/applications, site tours, home visits, and other follow-up to aid in the enrollment or education of a prospect or family/caregiver.
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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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