Regal Medical Group, Inc.
Provider Relations Network Manager
Regal Medical Group, Inc., San Bernardino, California, United States, 92409
Provider Relations Network Manager
#UHM-3747 Area of Interest:
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 the Inland Empire and surrounding areas. Position Summary: 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: Working collaboratively with the Director of Network Management and Medical Management team to ensure network growth and development initiatives are met and networks operate within budgets. Preparation and negotiation of provider contractual agreements during Primary Care, Specialty and Ancillary recruitment projects. New Provider and Staff Orientations and continued education of existing providers to ensure company programs and initiatives are effectively communicated and followed. Oversight of assigned networks to ensure provider deficiencies are being met. Maintaining and updating the appropriate databases and department tools with current information. Coordination, receipt, review, and processing of all provider contracts, credentialing, and correspondence. Timely and accurate completion of PACFs related to demographic changes in credentialing and provider network databases. Submitting provider profiles to Health Plans and conducting required follow-up. Review of Health Plan Directories and communication of adds/terminations/changes to the health plan. Assisting with the resolution of provider grievances and appeals. Daily interaction with regional providers with quarterly visits to PCP and Specialist offices. Ensuring contract compliance and adherence to regulatory agencies as required. Internal network liaison for various departments. Performing on-site visits to physicians, physician groups, hospitals, and ancillary providers. Facilitating quarterly Joint Operations Meetings with contracted providers. Oversight of database maintenance and accuracy through audits. Ensuring accurate and timely data reporting requirements are met. Following the Employee Handbook policies and procedures. Maintaining patient confidentiality in compliance with HIPPAA. Other duties as directed by management. 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 (Word, Excel, Outlook, Access, PowerPoint). Must be able to travel within service area 70-80% of the time and have valid driver’s license and insurance. Compensation: The pay range for this position at commencement of employment is expected to be $70,304 to $73,000 annually. The total compensation package may also include other elements, including a sign-on bonus and discretionary awards, in addition to a full range of benefits. Company Overview: As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group offers a fast-paced, exciting, welcoming, and supportive work environment. Full Time Position Benefits: We are dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy work-life balance. 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 Referral Bonus. Tuition Reimbursement. License Renewal CEU Cost Reimbursement Program. Business-casual working environment. Sick days. Paid holidays. Mileage reimbursement.
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#UHM-3747 Area of Interest:
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 the Inland Empire and surrounding areas. Position Summary: 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: Working collaboratively with the Director of Network Management and Medical Management team to ensure network growth and development initiatives are met and networks operate within budgets. Preparation and negotiation of provider contractual agreements during Primary Care, Specialty and Ancillary recruitment projects. New Provider and Staff Orientations and continued education of existing providers to ensure company programs and initiatives are effectively communicated and followed. Oversight of assigned networks to ensure provider deficiencies are being met. Maintaining and updating the appropriate databases and department tools with current information. Coordination, receipt, review, and processing of all provider contracts, credentialing, and correspondence. Timely and accurate completion of PACFs related to demographic changes in credentialing and provider network databases. Submitting provider profiles to Health Plans and conducting required follow-up. Review of Health Plan Directories and communication of adds/terminations/changes to the health plan. Assisting with the resolution of provider grievances and appeals. Daily interaction with regional providers with quarterly visits to PCP and Specialist offices. Ensuring contract compliance and adherence to regulatory agencies as required. Internal network liaison for various departments. Performing on-site visits to physicians, physician groups, hospitals, and ancillary providers. Facilitating quarterly Joint Operations Meetings with contracted providers. Oversight of database maintenance and accuracy through audits. Ensuring accurate and timely data reporting requirements are met. Following the Employee Handbook policies and procedures. Maintaining patient confidentiality in compliance with HIPPAA. Other duties as directed by management. 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 (Word, Excel, Outlook, Access, PowerPoint). Must be able to travel within service area 70-80% of the time and have valid driver’s license and insurance. Compensation: The pay range for this position at commencement of employment is expected to be $70,304 to $73,000 annually. The total compensation package may also include other elements, including a sign-on bonus and discretionary awards, in addition to a full range of benefits. Company Overview: As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group offers a fast-paced, exciting, welcoming, and supportive work environment. Full Time Position Benefits: We are dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy work-life balance. 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 Referral Bonus. Tuition Reimbursement. License Renewal CEU Cost Reimbursement Program. Business-casual working environment. Sick days. Paid holidays. Mileage reimbursement.
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