Job DescriptionResponsibilities include applying clinical knowledge, provider service orientation and strong communication skills toward developing and promoting a positive perception of the physical medicine and other assigned business units by cultivating a customer-oriented, collegial relationship with providers and clients. This position will primarily serve physical medicine (therapy and chiropractic) business and will be responsible for representing clinical and administrative aspects of Magellan programs. Specifically, this position be charged with conducting effective, clinically-substantive provider and client education and training programs for new network participants and new client implementations and when provider performance issues warrant remedial focus. Leads in responding to and resolving provider issues; facilitating problem-solving with other internal operations stakeholders and client provider relations staff to achieve fair and timely resolution and positive outcomes with providers. Additionally, requires being proactive in communicating with high-impact providers in each market to ensure that the highest provider satisfaction levels are achieved and client appreciation is gained as a result.
- Develop and conduct internal and external provider orientation, trainings, education meetings, presentations, and focus groups to improve mutual understanding and enhance working partnerships with providers.
- Oversee the high denial outreach, outlier, non-responder, and high appeals initiatives in all markets, initiating clinical education meetings with providers.
- Establish and maintain optimal communication channels with client provider relations and account management, promoting business unit's ability to rapidly resolve provider issues.
- Collaborate with network management, corporate management, account management, operations, clinical operations, QI and other internal stakeholders through internal meetings and needs analysis to develop and implement proactive provider relations improvement strategies.
- Provide summary and problem specific feedback information, analysis, action recommendations to service center senior management and relevant functional units regarding provider problems, issues, and general concerns impacting working relationships and Magellan image.
- Manage provider relation’s department day to day activity and staff.
- Track, direct, monitor, and trend, routine and long-standing provider complaints, claims, contracting, credentialing and other problems requiring regional service center follow-up and resolution.
- Facilitate immediate resolution of red-flag provider issues that are client, community, legal, or contractual threats with internal personnel as needed.Routinely monitor provider performance to target and perform remedial training sessions based upon area of need (e.g., authorization processes, claims submissions, clinical practice patterns etc.)
- Perform site visits for potential high volume and/or sensitive providers on ad-hoc basis.
General Job Information
TitleSenior Provider Relations Manager - Physical Medicine
Job FamilyOperations Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date1/28/2019
Date Requisition Created1/25/2019
EducationBachelors (Required), Masters
License and Certifications - RequiredDC - Doctor of Chiropractic, State Licensure - Care Mgmt, OT - Occupational Therapist, State Licensure - Care Mgmt, PT - Physical Therapist, State Licensure - Care Mgmt
License and Certifications - Preferred
Other Job Requirements
- 7+ years of experience 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.