Senior Provider Relations Manager, BH
San Diego CA 92108
Job DescriptionResponsibilities include applying clinical knowledge, provider service orientation and strong communication skills toward developing and promoting a positive perception of the behavioral health program and other assigned business units by cultivating a customer-oriented, collegial relationship with providers and clients. This position will primarily serve behavioral health and EAP 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.
- Develops and conducts internal and external provider orientation, trainings, education meetings, presentations, and focus groups to improve mutual understanding and enhance working partnerships with providers.
- Oversees the high denial outreach, outlier, non-responder, and high appeals initiatives in all markets, initiating clinical education meetings with providers.
- Establishes and maintains optimal communication channels with client provider relations and account management, promoting business unit's ability to rapidly resolve provider issues.
- Collaborates 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.
- Provides 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.
- May Manage provider relation’s department day to day activity and staff.
- Tracks, directs, monitors, and trends, routine and longstanding provider complaints, claims, contracting, credentialing and other problems requiring regional service center follow-up and resolution.
- Facilitates 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.)
- Performs site visits for potential high volume and/or sensitive providers on adhoc basis.
General Job Information
TitleSenior Provider Relations Manager, BH
Job FamilyOperations Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date1/29/2020
Date Requisition Created1/28/2020
Work ExperienceProvider Relations
EducationMasters: Behavioral Health (Required)
License and Certifications - RequiredLPC - Licensed Professional Counselor - Care Mgmt, LSW - Licensed Social Worker - Care Mgmt, MFT - Marriage and Family Therapist - Care Mgmt, PSY - Psychologist - Care Mgmt
License and Certifications - Preferred
Other Job Requirements
- Master's Degree in Social Work or Psychology.
- Social Work, Counselor, Psychology, Marriage & Family Therapy or Mental Health Counselor or related
- 7+ years clinical and/or provider relations experience.
- Knowledge of healthcare industry, health plan operations, and direct patient care clinical experience in relevant field behavioral health) required.
- Exceptional communication, presentation, organizational and interpersonal skills.
- Strong working knowledge of MS Office Suite and ability to quickly learn new software applications.
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.