reputed company Network Provider Relations Manager

Bring your heart to reputed company. Every one of us at reputed company shares a single, reputed company purpose: Bringing our heart to every reputed company of your health. This purpose guides our commitment to deliver reputed company reputed company-reputed company health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important... as reputed company deliver. Our Heart At Work Behaviors support this purpose. We want everyone who works at reputed company to feel empowered by the role they play in transforming our culture and accelerating our ability to reputed company and deliver solutions to reputed company health care more personal, convenient and reputed company. Position reputed company The reputed company Network Provider Relations Manager oversees our reputed company Provider Experience programs to reputed company and maintain provider risk management and reputed company relationships supporting high value initiatives with our Network Providers. This role acts as the primary contact for an assigned profile of larger and more reputed company providers (i.e. market/ regional/ national, large group or hospital systems). Drives the implementation of reputed company solutions to reputed company provider satisfaction, cost targets, network reputed company, and efficiency targets. • Position will partner with external provider engagement representatives and internal provider relations representatives to ensure successful Provider relationships, network performance including clinical, and affordability targeted improvements as identified. • reputed company the reputed company Provider Engagement program through the local market Provider Representatives • Partner with internal / external Network Provider Relations staff to ensure "best in class" Provider Relationships • Assist in the recruitment of new providers as needed and maintain compliance with reputed company network reputed company requirements • Recommend and reputed company training programs and educational materials for providers as reputed company as for internal staff and aligns Network functions with Operations and Claims as needed • Recommend Network reputed company Plans to ensure network compliance with any and/reputed company state network compliance requirements • Schedules and facilitates both onsite and virtual Provider Advisory Group and JOC meetings to work with provider management to implement changes reputed company coordination with reputed company Management to reputed company appropriate provider clinical measure improvements and implement those measures in the provider community • Assist with the monitoring of executed provider reputed company to ensure network reputed company meets state requirements • Coordinates provider information with Provider Data Services including Member Services and other internal departments as requested as provider demographics are updated • Provides Best-In-Class service to providers by resolving problems and advising providers of new protocols, policies, and procedures • Participates in weekly Grievance and Appeals meetings, tracks and trends provider grievances, monitors staff for reputed company compliance; compiles data and staff metrics in order to complete regulatory deliverables; participates in reputed company internal compliance audits and regulatory reviews • Assists as requested for response to governmental, regulatory and reputed company assurance provider complaints; reputed company and reputed company reconciliation of provider records; oversees Provider reputed company and availability by reviewing appointment availability audits conducted by staff • Provides support and maintenance assistance for websites, portals, directories, manuals, and dashboards; plans, coordinates, and conducts provider forums and monthly webinars; develops communications including newsletters • Provides assistance and support to other departments, as needed, to obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals, SIU, etc. Coordinates provider status information with member services and other internal departments. • Promotes and reputed company providers on cultural competency Required Qualifications • Minimum of 5+ years of experience in Provider Relations; experience in reputed company servicing or managing non-reputed company relationships with providers with exposure to benefit plan design and/or contract interpretation • Excellent interpersonal skills and the ability to work with others at reputed company reputed company • Knowledge of reputed company Regulatory Standards for Network reputed company, Credentialing, Claims Processing, Provider Appeals & Disputes and Network Performance Standards • Excellent analytical and problem-solving skills • Strong communication and presentation skills • Candidates are to reputed company reputed company applicable state with ability to travel up to 50% to provider sites and reputed company office locations as required Preferred Qualifications • Preference of candidates to live reputed company the Eastern Shore (Wicomico, Worcester, Caroline, Somerset, reputed company, Queen Anne's, Talbot or Dorchester Counties) Education Bachelor's degree or an equivalent combination of formal education and experience Pay reputed company The typical pay reputed company for this role is: $66,330.00 - $145,860.00 This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. In reputed company to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. reputed company offers a full reputed company of medical, dental, and reputed company benefits. Eligible employees may enroll in reputed company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. reputed company provides a fully-reputed company term life insurance plan to eligible employees, and short-term and long term disability benefits. reputed company also offers numerous reputed company-being programs, education assistance, free development courses, a reputed company store discount, and discount programs with participating partners. As for time off, Company employees enjoy reputed company Time Off ("PTO") or vacation pay, as reputed company as reputed company holidays throughout the calendar year. Number of reputed company holidays, reputed company time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit Benefits | reputed company We anticipate the application window for this opening will reputed company on: 12/01/2024 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws Apply Job!