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Trinity Health
Maywood
**Employment Type:** Full time **Shift:** Day Shift **Description:** The Regional Manager of Patient Relations is responsible for organizational compliance with patient rights laws, regulation and policy, and for provision of patient advocacy services across the Loyola Maywood campus and all off-site ambulatory locations. This position is responsib
Job Source: Trinity HealthCIBC
Chicago
We’re building a relationship-oriented bank for the modern world. We need talented, passionate professionals who are dedicated to doing what’s right for our clients. At CIBC, we embrace your strengths and your ambitions, so you are empowered at work. Our team members have what they need to make a meaningful impact and are truly valued for who they
Job Source: CIBCChicago Transit Authority
Chicago
Senior Coordinator, Employee Relations - ( 2400005U ) **Description** **POSITION SUMMARY** Under general direction, responsible for conducting full-life cycle employee-based investigations. Designs, plans, and coordinates employee-based investigations while ensuring compliance with established investigation procedures, policies, federal, state, and
Job Source: Chicago Transit AuthorityWSP USA
Chicago
What if you could work in a place full of opportunity and always find new ways to grow? We are seeking an **Assistant Vice President, Media and Public Relations.** This position can be based out of any of WSP regional office locations. This role is ideal for someone who excels in a fast-paced, dynamic environment and combines strong organizational
Job Source: WSP USABoundlessfellows
, IL, United States
At Carrum, we live and breathe the mission of transforming the healthcare system to create an unmatched experience for patients. If you are passionate about changing healthcare and want to finally get rid of surprise bills, poor quality, and high prices, while thriving in an entrepreneurial, cutting-edge environment, we would love to connect with y
Job Source: BoundlessfellowsBoundlessfellows
Chicago, IL, United States
At Carrum, we live and breathe the mission of transforming the healthcare system to create an unmatched experience for patients. If you are passionate about changing healthcare and want to finally get rid of surprise bills, poor quality, and high prices, while thriving in an entrepreneurial, cutting-edge environment, we would love to connect with y
Job Source: BoundlessfellowsClinical Professional Connections
Chicago, IL, United States
Job Description : Healthcare Sales and Provider Relations Manager POSITION # 060401 We are seeking a dynamic and motivated Healthcare Sales manager to join our team as a Provider Relations Manager for our Independent Physician Association (IPA). The primary goal of this role is to increase membership and strengthen relationships with local physici
Job Source: Clinical Professional ConnectionsCINQCARE
Chicago, IL, United States
CINQCARE Provider Engagement Account Manager Senior Position Description Overview The Provider Engagement Account Manager Sr. reports to the SVP of Provider Relations and Contracting and works very closely with the local IL Market President and leadership team. This position with accountability for providing strategy, judgment, organization, and ev
Job Source: CINQCAREChicago
Remote and must live in Illinois
**Job Description**
**Job Summary**
Molina Health Plan Network Provider Relations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Provider Relations staff are the primary point of contact between Molina Healthcare and contracted provider network. In partnership with Director, manages and coordinates the Provider Services activities for the state health plan. Works with direct management, corporate, and staff to develop and implement standardized provider servicing and relationship management plans.
**Job Duties**
Manages the Plan’s Provider Relations functions and team members. Responsible for the daily operations of the department working collaboratively with other operational departments and functional business unit stakeholders to lead or support various Provider Services functions with an emphasis on contracting, education, outreach and resolving provider inquiries.
• In conjunction with the Director, Provider Network Management & Operations, develops health plan-specific provider contracting strategies, identifying specialties and geographic locations on which to concentrate resources for purposes of establishing a sufficient network of Participating Providers to serve the health care needs of the Plan's patients or members.
• Oversees and leads the functions of the external provider representatives, including developing and/or presenting policies and procedures, training materials, and reports to meet internal/external standards.
• Manages and directs the Provider Service staff including hiring, training and evaluating performance.
• Assists with ongoing provider network development and the education of contracted network providers regarding plan procedures and claim payment policies.
• Develops and implements tracking tools to ensure timely issue resolution and compliance with all applicable standards.
• Oversees appropriate and timely intervention/communication when providers have issues or complaints (e.g., problems with claims and encounter data, eligibility, reimbursement, and provider website).
• Serves as a resource to support Plan’s initiatives and help ensure regulatory requirements and strategic goals are realized.
• Ensures appropriate cross-departmental communication of Provider Service’s initiatives and contracted network provider issues.
• Designs and implements programs to build and nurture positive relationships between contracted providers, ancillary providers, hospital facilities and Plan.
• Develops and implements strategies to increase provider engagement in HEDIS and quality initiatives.
• Engages contracted network providers regarding cost control initiatives, Medical Care Ratio (MCR), non-emergent utilization, and CAHPS to positively influence future trends.
• Develops and implements strategies to reduce member access grievances with contracted providers.
• Oversees the IHH program and ensures IHH program alignment with department requirements, provider education and oversight, and general management of the IHH program
**Job Qualifications**
**REQUIRED EDUCATION** :
Bachelor's Degree in Health or Business related field or equivalent experience.
**REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** :
• 5-7 years experience servicing individual and groups of physicians, hospitals, integrated delivery systems, and ancillary providers with Medicaid and/or Medicare products
• 5+ years previous managed healthcare experience.
• Previous experience with community agencies and providers.
• Experience demonstrating working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicare or Medicaid lines of business, including but not limited to: fee-for service, value-based contracts, capitation and delegation models, and various forms of risk, ASO, agreements, etc.
• Experience with preparing and presenting formal presentations.
• 2+ years in a direct or matrix leadership position
• Min. 2 years experience managing/supervising employees.
**PREFERRED EDUCATION** :
Master’s Degree in Health or Business related field
**PREFERRED EXPERIENCE** :
• 5-7 years managed healthcare administration experience.
• Specific experience in provider services, operations, and/or contract negotiations in a Medicare and Medicaid managed healthcare setting, ideally with different provider types (e.g., physician, groups and hospitals).
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
\#PJCorp
Pay Range: $59,810.6 - $129,589.63 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Email Alert for Manager, Provider Relations_ jobs in Chicago
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