Oversees and manages the functions of the Provider Relations Department to ensure maintenance or expansion of relationships that meet the business needs of the health plan.

Acts as liaison to physicians, hospitals, members, news media and the general public to ensure... [+] More

Oversees and manages the functions of the Provider Relations Department to ensure maintenance or expansion of relationships that meet the business needs of the health plan.

Acts as liaison to physicians, hospitals, members, news media and the general public to ensure effective communication and health plan updates. Responsible for hiring, developing and managing a qualified staff concerned with the maintenance and expansion of provider relationships within the health plan. Prepares and manages the departmental budget. Ensures that the plan has an adequate number of participating providers in the network to meet business objectives. Monitors the provider network to ensure proper recruitment, education and resolution of issues. Oversees contract negotiations with providers and evaluates the provider contracting strategy. Ensures that the provider network is trained. This position typically requires a Bachelor’s degree with five years of health plan experience. [-] Less

Oversees and... [+] More

Oversees and manages the functions of the Provider Relations Department to ensure maintenance or expansion of relationships that meet the business needs of the health plan. Supervises the provider relations staff, and implements strategies relative to the development and management of a provider network.

Develops programs to recruit, service, train, and reimburse physicians and providers. Designs and implements programs to maintain positive relationships between the health plan, physicians, providers, and practice managers. Typically requires a bachelor's degree with six years of health plan experience. Serves as a liaison between physicians, hospitals, members, news media, and the general public to ensure effective communication and health plan updates. Responsible for hiring, developing, and managing a qualified management staff concerned with the maintenance and expansion of provider relationships within the health plan. Ensures that the plan has an adequate number of participating providers in the network to meet business objectives. Monitors the provider network to ensure proper recruitment, education, and resolution of issues. Oversees contract negotiations with providers and evaluates the provider contracting strategy. Ensures that the provider network is trained. Prepares, manages, and monitors the departmental budget. [-] Less

Provides executive leadership and coordination over Provider Network Contracting operations to include development and implementation of strategic plans that provide sound provider interaction and contracting.

Responsible for the research, policy development, contract development and expansion of the provider network. Plans, organizes... [+] More

Provides executive leadership and coordination over Provider Network Contracting operations to include development and implementation of strategic plans that provide sound provider interaction and contracting.

Responsible for the research, policy development, contract development and expansion of the provider network. Plans, organizes and directs the Provider Network Contracting department. Organizes, controls, and evaluates the implementation of strategic plans that provide strong provider relations and contracting. Formulates and administers departmental policies. Plans, organizes, implements and evaluates outcomes of the department’s strategic plans. Develops strategic initiatives and transforms initiatives into action plans. Develops and fosters effective collaboration between departments and other affiliated services to ensure an integrated approach to provider network contracting. Develops new strategies to enhance service and improve overall performance. Develops and maintains administrative and regulatory compliance systems. Reviews budgetary recommendations, and manages and monitors the departmental budget. Hires, develops and motivates a qualified staff. An advanced degree is typically required for this position with seven years of provider relations and contracting experience in managed care. [-] Less

Oversees and... [+] More

Oversees and manages the functions of the Provider Relations Department to ensure maintenance or expansion of relationships that meet the business needs of the health plan. Supervises the provider relations staff, and implements strategies relative to the development and management of a provider network.

Develops programs to recruit, service, train, and reimburse physicians and providers. Designs and implements programs to maintain positive relationships between the health plan, physicians, providers, and practice managers. Typically requires a bachelor's degree with six years of health plan experience. Serves as a liaison between physicians, hospitals, members, news media, and the general public to ensure effective communication and health plan updates. Responsible for hiring, developing, and managing a qualified management staff concerned with the maintenance and expansion of provider relationships within the health plan. Ensures that the plan has an adequate number of participating providers in the network to meet business objectives. Monitors the provider network to ensure proper recruitment, education, and resolution of issues. Oversees contract negotiations with providers and evaluates the provider contracting strategy. Ensures that the provider network is trained. Prepares, manages, and monitors the departmental budget. [-] Less

Analyzes costs and member accessibility of current and prospective provider networks. Performs a general review of physician costs and practice patterns and analyzes costs and member accessibility of current and prospective provider networks. Typically requires a college degree and two... [+] More

Analyzes costs and member accessibility of current and prospective provider networks. Performs a general review of physician costs and practice patterns and analyzes costs and member accessibility of current and prospective provider networks. Typically requires a college degree and two years of experience in data collection and analysis. The position may require contract negotiation experience.

Coordinates and disseminates contract information for the organization. Identifies available networks in each market area and requests detailed provider information from each network vendor for analysis. Matches providers against actual claims experience and produces analyses and reports comparing costs and member accessibility of current network versus prospective network. Performs statistical testing of network vendor discounts. Analyzes general physician costs and utilization patterns by market area. Compares treatment patterns against peer group to identify providers with abnormal variances in cost-effectiveness. May negotiate managed care payer contracts and provider contracts. [-] Less

Monitors and coordinates governmental or private health care programs to ensure quality health care and facilitate claim processing, and negotiates contracts for health care programs between insurance companies and health care providers. Analyzes reports and documents regarding health care usage... [+] More

Monitors and coordinates governmental or private health care programs to ensure quality health care and facilitate claim processing, and negotiates contracts for health care programs between insurance companies and health care providers. Analyzes reports and documents regarding health care usage of program participants, utilizing computer; develops agenda to address issues; compiles list of recurring health care claims processing issues; and conducts information and training workshops with employees who process and file claims to resolve claim processing errors.

Formulates contract draft of agreement between participants of health care program, utilizing information, such as standard agreement procedures, insurance company policies, and governmental requirements, using computer. Presents health care program contracts to participating parties, discusses modifications suggested by parties involved, and obtains signatures of required representatives on new, renewed, or revised contracts. May monitor phone calls received by medical claim processors to evaluate services offered by employees. May investigate and resolve medical care provider claims reimbursement and program procedural problems. May review evaluation forms completed by workshop participants to determine whether workshop presentation covered processing errors. May specialize in contract negotiations or serve as consultant to facilitate claim processing. [-] Less

Plans and executes all aspects of a wide variety of an organization's special events, promotions, and activities as well as media and community relations projects. Works with media personnel, illustrators, photographers, advertising agencies, and Sales Promotion and Marketing Departments to... [+] More

Plans and executes all aspects of a wide variety of an organization's special events, promotions, and activities as well as media and community relations projects. Works with media personnel, illustrators, photographers, advertising agencies, and Sales Promotion and Marketing Departments to promote products and concepts of the organization through various advertising media and publications. Assumes an active role in community relations. Plans and implements advertising and public relations programs designed to increase business and to create and maintain favorable public image for the organization. Collaborates with organization's management team on strategies and plans to develop and execute organization events.

Reviews and approves media presentations. Tracks and manages research activities concerned with gathering information or statistics pertinent to planning and execution of sales promotion campaigns. Manages and administers the presentation and representation of the organization to employees, the general public, customers, and shareholders. Develops and produces publications, brochures, and press releases and articles to define the corporate identity to employees, customers, and the broader community. Directs or participates in the writing, editing, and publishing of organization advertisements and publications. Organizes and carries out events to promote employee morale and community goodwill, such as speeches, tours, exhibits, etc. Manages the flow of information to and from the press and other communications agencies. Cultivates and maintains relationships with editors, reporters, partners, customers, and investors. [-] Less

Manages and... [+] More

Manages and collaborates with others in planning, developing, recommending, and implementing employee relations programs, and maintains policies to ensure the uniform and equitable treatment of employees. Collects information on employees' attitudes and feelings about factors affecting worker morale, motivation, and efficiency, and provides reports of findings to management. Identifies, analyzes, and facilitates resolution of employee relations problems.

Coordinates employee grievance procedure and conducts exit interviews. Meets with shop stewards and/or supervisors to resolve grievances. Explains rules, policies, procedures, and company and governmental regulations to employees and emphasizes the need for compliance. Prepares and analyzes department budget to identify budget needs and/or reductions, and may allocate operating budget funds. Develops and implements methods and procedures for monitoring work activities, such as preparation of records of expenditures and progress reports, in order to inform management of current status or work activities. May recruit, hire, train staff, evaluate employee performance, and recommend or initiate promotions, transfers, and disciplinary action. May assist employees with relocation activities. May oversee an employee recognition program. May coordinate Affirmative Action program. [-] Less

Manages investor/shareholder relations activities, and communicates with and oversees those who communicate with and respond to inquiries and requests by investors or shareholder, which responses may require the analyses of records of present and past operations, trends and costs, estimated... [+] More

Manages investor/shareholder relations activities, and communicates with and oversees those who communicate with and respond to inquiries and requests by investors or shareholder, which responses may require the analyses of records of present and past operations, trends and costs, estimated and administrative commitments, and information.

Plans and handles meetings of investors and/or annual shareholders' meeting. Prepares meeting materials for investors. Assists in developing, implementing, and maintaining systems that provide control of investor/shareholder relations. Advises management regarding matters, such as effective use of resources and methods for increasing and obtaining goals. If the company stock is publicly traded, prepares notices to shareholder, Annual Reports (10-K) and Proxy (DEF-14) statements. Ensures information is in accord with the Securities and Exchange Commission and other regulations. Prepares budget and monitors and analyzes costs. Administers personnel functions, including recruiting, review and approval of job descriptions and salary classifications, and selection and placement of personnel. [-] Less

Manages labor-management... [+] More

Manages labor-management relations program of organization. Analyzes collective bargaining agreement to develop interpretation of intent, spirit, and terms of contract. Advises management and labor/union officials in development, application, and interpretation of labor relations policies and practices, according to policy formulated by upper management.

Interfaces with Labor Relations Representative in arranging and scheduling meetings between grieving workers, supervisory and managerial personnel, and a labor/union representative to investigate and resolve grievances. Identifies problem areas upon preparing statistical reports, using records of actions taken concerning grievances, arbitration and mediation cases, and related labor relations activities. Monitors implementation of policies concerning wages, hours, and working conditions to ensure compliance with terms of labor contract. Furnishes information, such as reference documents and statistical data concerning labor legislation, labor market conditions, prevailing union and management practices, wage and salary surveys, and employee benefits programs, for use in review of current contract provisions and proposed changes. May represent management in labor contract negotiations. [-] Less