Manages 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.
- 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.
Other Job Requirements
Responsibilities
7+ years' experience in a Provider Relations role for a managed care plan.
Bachelor's degree in a related field, or at least 4 additional years of experience in healthcare, network development or network management.
Solid knowledge of health plan operations required.
Knowledge of or experience in management of benefits and/or behavioral health required.
General Job Information
Title
Provider Relations Manager- Louisiana ECSS
Grade
25
Work Experience - Required
Network, Provider Relations
Work Experience - Preferred
Education - Required
A Combination of Education and Work Experience May Be Considered., Bachelor's
Education - Preferred
Master's
License and Certifications - Required
License and Certifications - Preferred
Salary Range
Salary Minimum:
$64,285
Salary Maximum:
$102,855
This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.
This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
