Job DescriptionManages the relationships with key health plans and provider networks for the purpose of implementing the company`s cost saving products into large markets nationally. Works daily to improve the relationships with health plan partners and resolves any outstanding issues that may develop. Increases the product for each health plan partner, and seeks medical cost saving programs for all members in the market. Enhances any process or procedure to best serve the Provider Network, and allows our program to be successful. Reports any high level issues for timely resolution and satisfaction.
- Assumes role in researching provider complaints and issues, collaborates with staff from various internal operations areas to determine root causes. Remedies problems, being on point to communicate with providers throughout the course of problem resolution.
- Coordinates cross departmentally to assure compliance with all regulatory and client requirements for Network access and adequacy
- Leads network compliance initiatives as they relate to network access and availability and complaint resolution.
- Takes the front-line in establishing and maintaining strong communications with providers. Collaborates with Regional Managers and manages staff and support activities.
- Develops and maintains strategic and tactical approaches to relating to high-impact providers in the network that will distinguish the company in the industry and result in peak provider satisfaction and network stability.
- Establishes and maintains optimal communication channels with client provider relations and account management to foster confidence in the company`s abilities to rapidly resolve provider issues.
- Identifies opportunities for promoting broader use of web services and proactively communicates with providers not taking full advantage of these services to understand why.
- Assists with network strategy committee meeting and network application processing decision committees
- Collaborates and monitors with credentialing teams to ensure provider compliance with provider and state contracts.
- Conducts training sessions for staff: provider relations and call center staff on contract and network management processing and policy in provider and contract management source systems.
General Job Information
TitleProvider Relations Manager
Job FamilyOperations Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date3/22/2019
Date Requisition Created3/22/2019
EducationBachelors (Required), Masters
License and Certifications - Required
License and Certifications - Preferred
Other Job Requirements
- 5-8 years in a Provider Relations role for a managed care plan.
- Solid knowledge of health plan operations required.
- Depending on assigned business unit, knowledge or experience in management of medical drug benefits, specialty pharmacy, pharmacy benefits management (PBM), behavioral health, or radiology may be required.
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.