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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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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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ResponsibilitiesThe Provider Relations Representative is responsible for establishing and maintaining positive relationships with various clients building strong, cohesive business partnerships.
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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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The Provider Recruiter and Relations Representative may work with providers on the TERM, and/or Medi-Cal Fee-For-Service (FFS) Network(s) as well as Off Panel, Out of Network providers, Skilled Nursing Facilities, Hospitals, which includes the San Diego County Psychiatric Hospital and/or Edgemoor Hospital, as well as other medical professionals.
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The applicant dentist is notified by the Talent Acquisition (for staff model) or Provider Relations (for IPA) representative of any missing documents, so that the missing documents may be collected or the erroneous information can be corrected in writing to the Talent Acquisition or Provider Relations representative within 30 days, which is then forwarded to the Credentialing Coordinator.
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Accountable for a full range of provider relations including engagement with and development of prospective providers. Responsible for a full range of provider relations and service interactions.
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Is looking to hire a Senior Provider Relations Representative for the greater Tampa area. Sr Provider Relations Rep will be responsible for provider contracting, day-to-day front line relationship management, training, education, population health, data sharing/connectivity, responding to provider inquiries, and other areas as they relate to provider performance, patient experience, market growth, provider experience and operational excellence.
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We are very excited to welcome a Provider Relations Representative to our team in the brand-new La Quinta market. · 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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Manage business, community, regulatory, governmental, and external board relations in their Market. Reporting to the regional president, and working directly with Hospital Presidents, the Market President is responsible for the strategic planning, operations, profit and loss (P&L), employee & provider engagement, and support services within the market.
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The MSR also assists in the case management of Health Service Utilization, Care Management, Radiology Benefit Manager, Transportation coordination, and the Pharmacy Department, by being the Plan's point of contact for the member and provider/pharmacies in the facilitation and coordination of services with the appropriate provider.
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Matrix Manager for JCC’s Panel Coordinators, Quality Improvement Analyst, Provider Relations Specialist, Innovation Specialist. Serve as a representative and spokesperson for the CCO in support of integration and coordination activities.
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Initiate and maintain effective channels of communication with our high-quality network of aligned providers through ownership of implementation and provider relations functions. We step in as the care provider and care planner that work to keep our participants within their communities, out of institutions, and cared for like family, all while receiving the healthcare and social services needed to thrive.
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The Market President is responsible for bringing together the entire IDN ( Integrated Delivery Network) or other network as applicable, driving growth and competitiveness within the Market while being the representative of CommonSpirit's mission, vision, culture, and value across the care continuum.
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Partner with Payer Strategy on payer management, reimbursements, and provider fees for the respective Market as directed by Division President. Working in partnership with the national clinical enterprise, the Market President assures quality of care patient experience, and care delivery are provided based on CommonSpirit Health-established goals to the communities within the market.
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