Network Provider Relations Manager, NJ/NY (Home Based)

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We work to be the best in our industry and work just as hard to be a fantastic employer. Come join our winning team and grow with us!

Located in Bethesda, MD, Managed Care Advisors (MCA) is an innovative company with a unique set of services specific to Specialized Health Program Management, Federal Workers’ Compensation, Employee Benefits, Disability Management and Absence Management. MCA has an immediate opening for a home based NJ/NY Network Provider Relations Manager for a highly visible health care program.

Managed Care Advisors

  • Provides an exciting and fast paced work environment
  • Celebrates our individual and team successes
  • Provides a comprehensive benefits package
  • Supports a team oriented work atmosphere

Summary

The Network Provider Relations Manager will be responsible for developing and maintaining a strong, quality provider network, recruiting and retaining network providers, and training and educating providers to ensure compliance with program procedures and regulations.  This includes being the liaison between the network providers and the program, developing, managing, and sustaining strong business relationships with network providers.  Responsibilities also include regular travel to the Greater New York area.

Professional Responsibilities

  • Establish and maintain strong relationships with providers to assure a stable quality network
  • Oversee the recruitment of primary and specialty providers as needed to meet health care program objectives
  • Provide direction for training and communications to achieve program goals and adhere to the program best practices
  • Oversee educating and training providers on policies and procedures to ensure compliance
  • Develop and evaluate the provider network to ensure appropriate access for membership
  • Propose and implement strategies to meet recruitment needs
  • Respond to requests for provider assistance, provider education and engagement
  • Manage and service network providers within assigned territory according to established guidelines
  • Work with offices to collect necessary contract and credentialing documents and follow up with providers on missing documents
  • Act as a liaison and assist offices with claims issues and other contract related issues
  • Manage the process of credentialing and re-credentialing
  • Manage work plans for staff in order to accomplish objectives
  • Provide continuous training to team members to ensure that they possess the required knowledge and information to effectively carry out their responsibilities
  • Adapt departmental plans and priorities to address business and operational challenges
  • Effectively maintain relationships with other department managers and serve as main liaison between care management and case managers
  • Create and maintain provider communications and training tools including provider relations newsletter, provider directory, and provider manual
  • Other tasks and duties as assigned

Requirements

  • Bachelor’s Degree
  • 5+ years’ experience in a network development management role handling complex networks while being accountable for individual and departmental results
  • 5+ years’ experience in the health care industry
  • 3+ years’ experience with provider contracting
  • 3+ years’ management experience

Soft Skills

  • Strong customer service skills
  • Excellent verbal and written communication skills; ability to speak clearly and concisely, ability to convey complex or technical information in plain English, as well as ability to understand and interpret complex information from others, including but not limited to reimbursement policy standards
  • Strong interpersonal skills, establishing rapport and working well with others
  • Ability to pass a preliminary credit and background check
  • United States Citizenship

The Company provides equal employment opportunities to all employees and applicants without regard to race, color, religion, sex, national origin, age, disability, genetics, or protected Veteran status. We participate in the United States Federal Government E-Verify program to confirm the employment authorization of each employee upon hire. A successful candidate will be required to undergo a criminal background check, and obtain and maintain confidential-level security clearance upon hire.

Please complete the job application below: