Provider Relations Manager

Job Description

Under the direction of the Director of Provider Services, this position oversees Provider Services Representatives in multiple locations to ensure we provide the highest level of service to providers. The Provider Services Manager is responsible for participating in the recommendation, development and implementation of quality of service strategies which improve operations and provider satisfaction. Provider Services Representatives encourage, facilitate, and maintain provider participation; recruit providers and act as an advocate on their behalf; promote provider engagement and facilitate an effective experience to advance CenCal Health’s strategic objectives.

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Qualifications

This position is responsible for: day-to-day supervision of Provider Services Representative (PSR) function including provider network development, recruitment, service and new provider orientations. The Provider Services Manager may also serve as a back-up representative to recruit, contract, educate, maintain, and improve provider participation and satisfaction for providers

· Manages day-to-day activities of Provider Services Representatives who recruit, contract, educate, maintain, and improve provider participation and satisfaction in an assigned territory

· Manages the JOC process development, data gathering, reporting and analysis to provide JOC partners with current data related to provider performance.

· Uses data analytics to inform recommendations and drive performance improvement in HEDIS, cost containment, and regulatory compliance.

· Oversees service to providers including initial orientations, on-site visits, and intervention and communication with providers

· Coordinates activities of PSRs to improve satisfaction and manage relationships between CenCal Health and network providers in the service area

· Manages and is accountable for the timely and appropriate resolution of provider issues and participate in quality assurance procedures by reviewing satisfaction surveys and performing follow-up calls as necessary

· Ensures contract compliance of, and access to, provider network for all new and existing programs in given region

· Monitors identified access barriers, billing and reimbursement trends and utilize for provider retention or recruitment purposes

· Advocates on behalf of providers during escalated issues as applicable by investigating provider issues

· Works side-by-side with PSRs to support them while preparing recommendations for resolution and composing responses as needed

· Monitors task completion and recommends improvements to processes and workflows

· Evaluates effectiveness of service to providers within the PSR function

· Supports staff and collaborates with Leadership Team

· Assists the Director of Provider Services with projects as necessary, including compliance with regulatory responsibilities

· Make recommendations to Director for improvement of any and all procedures and systems at CenCal Health

· Other duties and tasks as needed and assigned

Additional Information

If you are interested in joining the team at CenCal Health, please apply at:

https://recruiting2.ultipro.com/SAN1015SBHA/JobBoard/be64234c-c47d-4274-b3c6-8cac051e31e3/?q=&o=postedDateDesc