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Manage negotiation, operation, and administration of liaison activities associated with healthcare provider contracting for the TriWest Veteran Administration (VA) Community Care Network (CCN) for the state of New Mexico.
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NETWORK RELATIONS - Manage negotiation of various contract rates and reimbursement methodologies for all network agreements, ensuring compliance with the VA, TriWest, Medicare, or industry regulations, as appropriate.
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Demonstrated or equivalent experience in leading all aspects of provider network activities, including network development, value based contracting strategies and negotiations, and provider servicing and relations which will facilitate the creation and maintenance of a high performing, accountable and engaged provider network.
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Experience in physician relations, network, marketing, or business development preferred. The Palmdale Regional team is seeking a Director of Provider Relations who will strategically plan, implement, and lead outreach efforts designed to foster physician alliance and improve relationships within healthcare community markets and service areas.
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Provider Relations Representative works as the primary liaison between Community First Health Plans and network participants (physicians, providers, and administrators) of the health plan provider network.
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5+ years of Managed Care Provider Contracting, Provider Relations or Physician Network development experience. Humana Healthy Horizons in Virginia is seeking a Director, Provider Engagement who will oversee the plan's strategic provider services model, including direct reports responsible for Provider Relations, Provider Engagement and Network Development.
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Recent experience as a provider relations representative, member service representative, or relevant claim experience is highly preferred. The Provider Relations Representative knows and abides by all organizational and departmental policies, sets personal standards, and strives for high quality work in completing assignments, performs job duties in a timely manner, and represents the organization in a positive manner.
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Director of Provider Relations. Minimum seven (7) years of experience in healthcare sales or network development environment required. Excellent human relations skills with the ability to impact and influence results.
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NETWORK RELATIONS - Serve as primary interface and liaison with TriWest CCN network administration, management, and staff, as needed to execute contracts, resolve contractual problems and issues, and provide information and instruction.
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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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The ideal candidate will have extensive business leadership experience, with several years in a managed care environment leading a network development/provider relations function, including proven experience leading contracting for Medicare products.
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The Sr Manager I (Provider Data Management Services) will manage all workflows and operations within the Provider Data Management Services (PDMS) department to ensure accurate claims payment, timely data configuration, network adequacy and compliance.
$117,000 - $192,390 a yearFull-timeRemoteExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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The Manager of Provider Relations will serve as the point person for managing the day-to-day relationship between MetroPlusHealth and top level administrators at each assigned network facility and community providers.
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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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MAJOR DUTIES AND RESPONSIBILITIES Lead and develop recommendations for high priority Provider Relations projects and initiatives related to network strategy and provider economics.
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