Managed Care Provider Relations Manager jobs in California

Managed Care Provider Relations Manager develops, manages, and sustains relationship with members of physician network of managed care service providers. Recruits new physicians and manages the credentialing and orientation process. Being a Managed Care Provider Relations Manager serves as a resource for physicians, answering questions and providing information about network procedures or contracts. Monitors provider performance and resolves any issues. Additionally, Managed Care Provider Relations Manager reviews billings and claims payments according to managed care contracts. Requires a bachelor's degree. Typically reports to the head of a unit/department. The Managed Care Provider Relations Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Managed Care Provider Relations Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)

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Manager Provider Data Management – Managed Care - (LA8996)
  • 3 Key Consulting
  • Los Angeles, CA FULL_TIME
  • Job Title:  Manager Provider Data Management – Managed Care - (LA8996)
    Location: Los Angeles, CA. 90017
    Duration: 3 months with possible extensions OR conversion to permanent
    Business Unit: Provider Data Management
    Employment Type:  Contract
    Posting Date: 02/16/2023
    Notes: Only qualified candidates need apply.

    3 Key Consulting is recruiting a Manager Provider Data Management for a consulting engagement with our direct client, a leading global biopharmaceutical company.

    Job Description:
    The Manager of Provider Data Services provides leadership, supervision, and direction to support the operation and analytic functions of Provider Data Services unit's daily operations, including developing and applying departmental strategies; co-leads or leads enterprise-wide data management initiatives. The Manager participates as a liaison between client and its external and internal business partners to support business imperatives and data analysis and to drive positive business outcomes. 

     This position supports client’s leadership's strategy and drives the execution and operation of:
    • Provider Network Management.
    • Provider Data Management.
    • Medi-Cal Business partner’s Account Management team.

    Through a systematic and disciplined approach, the Manager oversees and manages technical deliverables to ensure data production and processing meets the enterprise's specifications, furthermore the Manager will work strategically with client’s leadership to provide analytical information in support of the organization's strategic goals.  

    The Manager, Provider Data Services has a strong knowledge of the healthcare market and technical capacity to ensure alignment of health plan operation, policies, regulatory requirements and implementation of IT data analytical services. 

    Top Must Have Skill Sets:
    • 5-7 years of direct experience developing complex data processing tasks
    • 3 years health care experience
    • 3 years of progressive Supervisory experience

    Day to Day Responsibilities:
    • Ability to understand business needs and translate those needs into specific requirements in both accurate business and technical terminologies based on the audience.
    • Excellent analytical thinking and ability to perform root cause analysis.
    • Drives work progress through strong leadership skills and ability to leverage healthcare and IT knowledge to drive outcomes.
    • Ability to plan for and articulate decision impacts across business processes and applications.   Perform other duties as assigned.

    Basic Qualifications:
    • Bachelor's Degree in Information Systems or Related Field In lieu of degree, equivalent education and/or experience may be considered.
    • 5-7 years of direct experience developing complex data processing tasks - ETL, data manipulation, and data build in RDBMS with multi-millions to billions’ data records (1 TB data volume).  
    • 5-7 years of data quality management and data analytical experience.
    • 3-5 years of healthcare experience.
    • 3-4 years of progressive supervision and management experience.
    • 3 years of IT application end-to-end (raw data to UI) development work experience.
    • 2 years of data modeling experience. 
    • 2 years of project/program management experience. 
    • 2 years of BPM and business process improvement experience.
    • Experience on BI tools.
    • Experience on NoSQL environment.  

    Preferred Qualifications:
    • Master's Degree in Information Systems or Related Field
    • Experience working with managing programs or other managerial experience.
    • Managed care experience.
    • Data management experience in Master Data Management (MDM) - data model and business rules.
    • Experience of vendor management (software and workforce) experience.
    • Experience of procurement management in contract negotiation, Request of Proposal (RFP), Master Service Agreement (MSA), Statement of Work (SOW) creation.
    • Data management experience in Master Data Management (MDM) - data model and business rule.

    Interview Process:
    First interview with Director and second with team

    We invite qualified candidates to send your resume to resumes@3keyconsulting.com.  If you decide that you’re not interested in pursuing this particular position, please feel free to take a look at the other positions on our website www.3keyconsulting.com/careers. You are also welcome to share this opportunity with anyone you think might be interested in applying for this role.
  • 7 Days Ago

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Credentialing and Contracting Medical Provider Network Specialist
  • TRISTAR MANAGED CARE INC
  • Fresno, CA FULL_TIME
  • This will be a remote position. JOB SUMMARY: The Credentialing and Contracting Specialist is responsible for preparing and maintaining contracts and the contracts database system. Maintain active stat...
  • 27 Days Ago

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Managed Care - Contracts Manager
  • College Health Enterprises
  • Santa Fe, CA FULL_TIME
  • College Health Enterprises is one of the fastest growing health systems in Southern California. We are dedicated to the highest quality of customer services delivered with a with a sense of warmth fri...
  • 9 Days Ago

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Managed Care Manager
  • Northeast Community Clinic
  • Alhambra, CA FULL_TIME
  • Job DescriptionJob located in Alhambra, CA, USAPosition SummaryUnder the direction of the Operations Director and Executive Director, this position is responsible for the negotiation, optimization and...
  • 15 Days Ago

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Provider Relations Manager
  • Behavior Treatment & Analysis
  • WALNUT CREEK, CA FULL_TIME
  • General Description: The Clinical Behavioral Assessment Manager is the lead assessor for initial assessment and is responsible for assisting with client’s initial assessments, writing individualized r...
  • 2 Days Ago

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Provider Relations Manager
  • Episource, LLC.
  • Gardena, CA FULL_TIME
  • Advance Possibility Join Episource, a leading provider of risk-adjustment services, software, and solutions for health plans and medical groups. Bring your passion for medical records retrieval and dr...
  • 3 Days Ago

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Relationship Manager
  • Ascensus
  • Greensboro, NC
  • Newport, an Ascensus company, helps employers offer their associates a more secure financial future through retirement p...
  • 6/11/2024 12:00:00 AM

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Relationship Manager
  • GROVER GAMING
  • Elyria, OH
  • Job Description Job Description Job Title: Relationship Manager Department: Ohio Sales Reports To: Sales Manager Status:...
  • 6/11/2024 12:00:00 AM

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Relationship Manager
  • Allium Financial Advisors, LLC
  • Lake Oswego, OR
  • Summary This position is responsible for partnering with Financial Advisors to help manage client relationships by perfo...
  • 6/10/2024 12:00:00 AM

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Relationship Manager
  • Flourish
  • New York, NY
  • Flourish was founded in 2017 with the goal of helping financial advisors to better secure the financial futures of their...
  • 6/9/2024 12:00:00 AM

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Relationship Manager
  • Wind River Payments
  • Madison, WI
  • As a Relationship Manager at Wind River Payments (WRP), you will thrive on building strong, long-term client relationshi...
  • 6/9/2024 12:00:00 AM

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Relationship Manager
  • Palmetto
  • Company Description Recognized by Forbes as one of the fastest-growing private companies in the United States, Palmetto ...
  • 6/7/2024 12:00:00 AM

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Relationship Manager
  • Valley Bank
  • Jacksonville, FL
  • Why you should consider applying to this opportunity: You're excited to build relationships with Commercial & Industrial...
  • 6/7/2024 12:00:00 AM

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Relationship Manager
  • Team Select Home Care
  • Evansville, IN
  • Overview: You can apply by texting TSC to 97211 Now offering DailyPay! Ask us about it! Are you looking for an exciting ...
  • 6/7/2024 12:00:00 AM

California is a state in the Pacific Region of the United States. With 39.6 million residents, California is the most populous U.S. state and the third-largest by area. The state capital is Sacramento. The Greater Los Angeles Area and the San Francisco Bay Area are the nation's second and fifth most populous urban regions, with 18.7 million and 9.7 million residents respectively. Los Angeles is California's most populous city, and the country's second most populous, after New York City. California also has the nation's most populous county, Los Angeles County, and its largest county by area, S...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Provider Relations Manager jobs
$111,791 to $161,262

Managed Care Provider Relations Manager in Trenton, NJ
Rizk says McKesson has created a collegial relationship by reaching out to providers.
January 03, 2020
Managed Care Provider Relations Manager in Gary, IN
Aetna (57% favorable/37% unfavorable) has turned around providers by changing leadership and addressing provider concerns.
February 24, 2020
Managed Care Provider Relations Manager in Birmingham, AL
Providers "want legitimate, honest P4P programs, data exchange, streamlined business processes, and clarity.
November 28, 2019