Current jobs related to Provider Relations Network Manager - Orange - Regal Medical Group
-
Provider Network Manager
4 weeks ago
Orange, United States Sonrava Health Full timeOverview The Provider Network Manager will be responsible for assigned local (Los Angeles or Sacramento County) and out of state dental plan processes and activities necessary to develop and maintain the provider network and financing system. Responsible for project management, metrics and internal communication to Operation departments. Team lead and...
-
Provider Network Manager
1 week ago
Orange, California, United States Sonrava Health Full timeJob Title: Provider Network ManagerAt Sonrava Health, we are seeking a highly skilled Provider Network Manager to join our team. As a key member of our operations department, you will be responsible for developing and maintaining a competitive network of providers, ensuring network providers understand and adhere to company goals and initiatives, and...
-
Provider Relations Specialist
4 weeks ago
Orange, California, United States Astiva Health, Inc Full timeJob Title: Provider Relations Coordinator (Bilingual - Korean, Vietnamese, or Chinese)Target Compensation Range: $26.00/hour, depending on the relevant qualifications and experience.About Us:Astiva Health, Inc. is a leading healthcare organization focused on Medicare and HMO services. We are dedicated to providing comprehensive care that meets the diverse...
-
Provider Relations Specialist
4 weeks ago
Orange, California, United States Astiva Health, Inc Full timeJob Title: Provider Relations Coordinator (Bilingual - Korean, Vietnamese, or Chinese)Target Compensation Range: $26.00/hour, depending on the relevant qualifications and experience.About Us:Astiva Health, Inc. is a leading healthcare organization dedicated to Medicare and HMO services. We focus on delivering inclusive care tailored to the diverse needs of...
-
Provider Relations Coordinator
3 days ago
Orange, United States Astiva Health, Inc Full timeJob Title: Provider Relations Coordinator (Bilingual - Korean, Vietnamese, or Chinese)Target Compensation Range: $22.00 - $26.00/hour, depending on the relevant qualifications and experience.About Us:Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive...
-
Provider Relations Coordinator
3 days ago
Orange, United States Astiva Health, Inc Full timeJob Title: Provider Relations Coordinator (Bilingual - Korean, Vietnamese, or Chinese)Target Compensation Range: $22.00 - $26.00/hour, depending on the relevant qualifications and experience.About Us:Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive...
-
Management Services Coordinator
3 weeks ago
Orange, California, United States Department of Industrial Relations Full timeJob SummaryThe Department of Industrial Relations is seeking a highly skilled Management Services Coordinator to join our team. As a key member of our staff, you will be responsible for providing administrative support and coordinating public records requests in accordance with the Government Code.Key ResponsibilitiesCoordinate and respond to public records...
-
Network Administrator
1 week ago
Orange, United States Robert Half Full timeJob DescriptionJob DescriptionWe are offering an exciting opportunity for a Network Administrator based in Orange, Connecticut. This role primarily involves providing technical support, maintaining network infrastructure, and ensuring the smooth operation of computer systems within our industry. Responsibilities:• Provide technical assistance to users,...
-
Healthcare Provider Liaison
2 days ago
Orange, California, United States Astiva Health, Inc Full timeProvider Relations CoordinatorAstiva Health, Inc. is seeking a highly skilled Provider Relations Coordinator to join our team in Orange, CA. As a key member of our healthcare team, you will be responsible for building and maintaining strong relationships with our network providers, ensuring seamless operations and exceptional provider satisfaction.Key...
-
Sr. Network Architect
2 months ago
Orange, United States Irvine Technology Corporation Full timePosition: Sr. Network ArchitectLocation: Orange, CA (Hybrid = 95% Remote / 5% Onsite)Work Model: Hybrid, 95% Remote / 5% OnsiteDuration: Direct HireSalary: 150k to 200k + Excellent Benefits ProgramIndustry: HealthcareResponsibilities:Engages in architecture definition, planning, technology direction, project management as well as mentoring of network...
-
Sr. Network Architect
2 months ago
Orange, United States Irvine Technology Corporation Full timePosition: Sr. Network ArchitectLocation: Orange, CA (Hybrid = 95% Remote / 5% Onsite)Work Model: Hybrid, 95% Remote / 5% OnsiteDuration: Direct HireSalary: 150k to 200k + Excellent Benefits ProgramIndustry: HealthcareResponsibilities:Engages in architecture definition, planning, technology direction, project management as well as mentoring of network...
-
Management Services Technician
2 weeks ago
Orange, California, United States Department of Industrial Relations Full timeJob Description and DutiesThe Management Services Technician will work under the supervision of the Presiding Workers' Compensation Judge and receive general direction from the Associate Chief Judge. The incumbent will learn and perform semi-professional analytical tasks related to Public Records Act requests received for the assigned district...
-
Member Relations Representative
3 weeks ago
Orange, United States Alta Hospitals Full timeThe Member Relations Representative is responsible for acting as a liaison between members, health plans, and physicians. Individuals are required to perform at minimum 120 outbound attempts per day to Medi-Medi, Medicare, Commercial, POS and Medi-Cal members who are existing members with enrollment errors or are identified as potential terminations and...
-
Member Relations Representative
3 weeks ago
Orange, United States Alta Hospitals Full timeThe Member Relations Representative is responsible for acting as a liaison between members, health plans, and physicians. Individuals are required to perform at minimum 120 outbound attempts per day to Medi-Medi, Medicare, Commercial, POS and Medi-Cal members who are existing members with enrollment errors or are identified as potential terminations and...
-
Urogynecology Nurse Practitioner
4 weeks ago
Orange, California, United States Provider Solutions & Development Full timePosition OverviewWe are currently seeking a dedicated part-time Nurse Practitioner to become a vital member of our esteemed Urogynecology practice. This role is designed for an outpatient setting where the Nurse Practitioner will collaborate with two skilled surgeons, primarily focusing on managing patients with lower acuity needs. The ideal candidate will...
-
Senior Legal Typist
2 weeks ago
Orange, California, United States Department of Industrial Relations Full timeJob Summary We are seeking a highly skilled and detail-oriented Senior Legal Typist to join our team at the Department of Industrial Relations. As a Senior Legal Typist, you will play a critical role in supporting the administration of workers' compensation claims and providing secretarial and clerical support to our Workers' Compensation Judges. Key...
-
Senior Product Manager
2 weeks ago
Orlando,FL-S Orange Ave, United States Cognizant Full timeAbout the RoleCognizant is a leading professional services company that helps clients transform their business, operating, and technology models for the digital era. Our industry-based, consultative approach enables clients to envision, build, and run more innovative and efficient businesses.We are seeking a Senior Consultant who can deliver within...
-
Senior Employee Relations Specialist
4 months ago
Orange, United States Chapman University Full timeJob Description Summary Reporting jointly to the AVP of Employee Relations Services and to the Equal Opportunity Director (EODO) in a matrix reporting model, the Sr. Employee Relations Specialist supports two business units: Employee Relations and Equal Opportunity, with primary focus being Employee Relations. The incumbent supports an array of functions...
-
Lead Employee Relations Consultant
4 weeks ago
Orange, California, United States Chapman University Full timeSenior Employee Relations Specialist at Chapman University:The Senior Employee Relations Specialist is essential in providing support to the Employee Relations and Equal Opportunity divisions, primarily focusing on Employee Relations. This role encompasses addressing intricate issues, delivering guidance, and offering counseling to resolve employee inquiries...
-
Lead Employee Relations Consultant
4 weeks ago
Orange, California, United States Chapman University Full timeSenior Employee Relations Specialist at Chapman University:The Senior Employee Relations Specialist is integral to the support of the Employee Relations and Equal Opportunity sectors, primarily concentrating on Employee Relations. This role encompasses the resolution of intricate issues, providing guidance, and offering counsel to address employee grievances...
Provider Relations Network Manager
4 months ago
Provider Relations Network Manager
#UHM-2840
{{jcity}}{{jstate}}
Provider Network
Position Type
Full-time
Job Description
We are looking to hire a Provider Relations Network Manager to help support our Provider Relations Network Management team in Southern California in Orange County and surrounding areas.
The Provider Relations Network Manager is responsible for general management of the provider network as assigned by the Director of Network Management as well as for supporting the Network Management Department in meeting the overall network growth and development goals.
Essential Duties and Responsibilities include the following:
Responsible for working collaboratively with the Director of Network Management and Medical Management team to ensure network growth and development initiatives are being met and are networks are operating within budgets.
Responsible for the preparation and negotiation of provider contractual agreements during Primary Care, Specialty and Ancillary recruitment projects.
Responsible for New Provider and Staff Orientations and continued education of existing providers to ensure company programs and initiatives (i.e. P4P, HCC, Vital Care, Encounters, etc.) and process is being effectively communicated and followed by the provider network. Also, to ensure provider is effectively utilizing company tools (i.e. REA, iCode, etc.) available to them.
Responsible for the oversight of their assigned networks to ensure network provider deficiencies are being met and working closely with their assigned
Network Support staff and Medical Management counterparts to ensure network needs/changes are being effectively addressed and communicated both internally and externally.
Maintaining and updating the appropriate databases and department tools with current information.
Responsible for the coordination, receipt, and review and processing of all provider contracts, credentialing, and provider correspondence to ensure the department has obtained proper signatures and documentation to effectively process newly recruited or existing providers.
Responsible for timely and accurate completion of PACF’s related to incoming documentation received from providers regarding changes to their demographic information in the credentialing and provider network databases.
Responsible for submitting provider profiles to the Health Plans, conducting required follow-up to ensure Primary Care Physicians are active in health plan databases and obtaining health plan assigned provider identification numbers in affiliation with Regal. Also, responsible to ensure terminated PCP’s are effectively terminated and enrollment retention efforts are followed.
Responsible for the review of Health Plan Directories for assigned network/s as well as communication of adds/terminations/changes to the health plan.
Assist with the resolution of provider grievances and appeals in accordance with contractual requirements and corporate policy.
Daily interaction with regional providers and at minimum quarterly visits to PCP and Specialist offices unless visit is warranted at earlier.
Ensure contract compliance and adherence to DMHC, DHS, CMS and other regulatory agencies as required by company policy and contracting HMOs.
Internal network liaison for Database, Claims, Customer Service, Medical Management, and Quality Management Departments.
Perform on-site visits (as required) to physicians, physician groups, hospitals and ancillary providers.
Facilitate the quarterly Joint Operations Meetings with contracted providers and office staff.
Oversight of database maintenance and accuracy through use of audits.
Ensure accurate and timely data reporting requirements are being met including eligibility and capitation reports, risk sharing, claims timeliness, pharmacy utilization, bed day’s utilization, encounter data and audit compliance.
Know and follow the Employee Handbook policies and procedures.
Maintain patient confidentiality so that HIPPAA compliance is observed at all times.
Other duties directed by management.
Distribution of work:
Daily production will vary from day to day. All assigned work must be completed by the end of business day in order to maintain turnaround time compliance.
Special Projects:
Assist with any special projects.
Education and/or Experience:
Minimum of 3 years relevant work experience in Network Management, Contracting or Provider Relations in a managed care setting, health plan or large medical group administration.
Knowledge of contracting principles/tools.
Excellent verbal and written communication skills.
Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access and Power Point)
Must be able to travel within service area 70-80% of the time and have valid driver’s license and insurance.
The pay range for this position at commencement of employment is expected to be $70,304/year however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.
The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.
Details of participation in these benefit plans will be provided if an employee receives an offer of employment.
If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.
As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.
Full Time Position Benefits:
The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.
Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.
Health and Wellness:
Employer-paid comprehensive medical, pharmacy, and dental for employees
Vision insurance
Zero co-payments for employed physician office visits
Flexible Spending Account (FSA)
Employer-Paid Life Insurance
Employee Assistance Program (EAP)
Behavioral Health Services
Savings and Retirement:
401k Retirement Savings Plan
Income Protection Insurance
Other Benefits:
Vacation Time
Company celebrations
Employee Assistance Program
Employee Referral Bonus
Tuition Reimbursement
License Renewal CEU Cost Reimbursement Program
Business-casual working environment
Sick days
Paid holidays
Mileage
Requirements
Education and/or Experience:
Minimum of 3 years relevant work experience in Network Management, Contracting or Provider Relations in a managed care setting, health plan or large medical group administration.
Knowledge of contracting principles/tools.
Excellent verbal and written communication skills.
Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access and Power Point)
Must be able to travel within service area 70-80% of the time and have valid driver’s license and insurance.
#J-18808-Ljbffr