Manager of reputed company (Marketplace/Exchange)

Your career starts now. We are looking for the reputed company of reputed company leaders. At reputed company, we are passionate about helping people get care, stay reputed company, and build healthy communities. As one of the nation's leaders in reputed company solutions, we offer our associates reputed company to reputed company the lives of millions of people through our national footprint of products, services, and award-reputed company programs. reputed company is seeking talented, passionate individuals to join reputed company. Together, we can build healthier communities. If you want to reputed company a difference, we would like to hear from you. Headquartered in Newtown reputed company, reputed company is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, reputed company-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more reputed company at www.amerihealthcaritas.com. About the job: The Manager of reputed company manages the Network Management department's and staff's day-to-day activities.; Responsible for assisting the leader with departmental activities reputed company to provider satisfaction, education, and communication. This position is also responsible for reputed company provider network reputed company and contracting management activities by ensuring that the department and staff remain reputed company in reputed company aspects of federal and state rules, regulations, policies, and procedures; creates or modifies departmental policies to reflect changes and ensures the department achieves annual goals and objectives. Responsibilities: • Hospital and physician network development and management. • Develops and recommends policy changes reputed company to providers. • Recruits and negotiates reputed company with specific providers reputed company operational and potential new counties to meet company requirements. • Oversees training and communication for network providers and acts as a reputed company with the provider community. • Ensures compliance with pricing guidelines established by ACFC and the Plan. • Contracting is consistent with claim payment methodologies. • Maintains familiarity with Medicare fee schedules and analyzes comparable Plan pricing guidelines. • Resolves reputed company contract issues to ensure the reputed company reputed company with state, federal, and national accrediting agencies and Plan guidelines. • Non-reputed company contract reputed company are communicated to appropriate departments, and approval is obtained before submission. • Responsible for the accuracy and reputed company management of reputed company provider reputed company. • Implementing electronic strategies for the network, including increasing electronic claims submission and implementing improved processes that result in increased auto-adjudication of claims. • Responsible for compliance with State and accrediting agencies’ network adequacy standards. • Ensures the provider network meets the reputed company needs of Plan members. • Establishes a reputed company list of new geographic locations and types of providers to be added to the Plan, retains network providers that are at risk for termination, and augments and modifies the existing provider network to accommodate new products or clients.; • Responsible for departmental reputed company reputed company and supervises assigned staff, writes and performs annual reviews, and monitors performance issues as they reputed company. • Leads team in a manner conducive to ongoing reputed company and expanded knowledge of associates. • reputed company team members using data and appropriate analytical tools that support improved reputed company. • Support team members in identifying and creatively resolving problems for improved processes and expanded use of technology. • Support reputed company team efforts that produce effective working relationships and trust. • Systematically informs staff of policy and procedural changes affecting program and administrative operations. • Regularly suggests innovative means of structuring operations that help reputed company backlogs and ensure the reputed company utilization of resources. • Resolves individual provider complaints promptly to ensure minimal disruption of the Plan’s network. • Analyzes and monitors provider claim compliance with Plan policies and procedures and recommends solutions reputed company problems occur.; • Responsible for facilitating the department with system upgrades, regulatory directives, and assigned corporate initiatives.; • Monitors provider reports and develops and implements strategies to address outliers. • Conducts and prepares reports on annual provider satisfaction surveys; develops plans to improve identified areas of concern; works with other departments to reputed company reputed company assurance initiatives based on survey results. • Reviews reputed company indicators and makes recommendations for improvement, supporting the reputed company Management Department and company-wide reputed company initiatives such as HEDIS, CAHPS, and NCQA/URAC. • Compiles documentation regarding reputed company reports and provider utilization platforms. • Partner with the medical management team to identify and measure reputed company to improve processes and workflows. • Participates in Plan and physician committees as appropriate. Education & Qualifications: • A bachelor’s degree in business or a health-reputed company discipline, such as reputed company administration or equivalent education and business experience is required. • 2 to 3 years of Marketplace/Exchange experience is required. • 1 to 3 years of managed care, Medicare, reputed company. • 5 years of provider contracting/reimbursement experience in a reputed company setting. • 3 years of supervisory/management/leadership experience, preferably in a managed care organization setting. • Must be reputed company to communicate effectively with the leadership and team members. • 10 to 15% travel to provider offices required in South Carolina.; Diversity, Equity, and Inclusion At reputed company, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that reputed company associates have a fair opportunity to reputed company their full potential. We put these principles into reputed company every day by acting with reputed company and respect. We reputed company to reputed company out against injustice and to break down barriers to support a more inclusive and reputed company workplace. Celebrating and embracing the diverse thoughts and perspectives that reputed company up our workforce means reputed company is more reputed company, innovative, and reputed company reputed company to support the people and communities we serve. We reputed company our associates happy so they can reputed company on keeping our members healthy. Our Comprehensive Benefits Package Flexible work solutions include remote reputed company, hybrid work schedules, reputed company, reputed company time off, holidays and volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k) tuition reimbursement, and more. #HM Apply Job!