Provider Relations Manager- REMOTE

Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.

Job Posting Title

Provider Relations Manager- REMOTE

Job Description Summary

Manages the relationships with key health plans and provider networks for the purpose of implementing the company`s cost saving products into large markets nationally. Works daily to improve the relationships with health plan partners and resolves any outstanding issues that may develop. Increases the product for each health plan partner, and seeks medical cost saving programs for all members in the market. Enhances any process or procedure to best serve the Provider Network, and allows our program to be successful. Reports any high level issues for timely resolution and satisfaction.

Job Description

• Assumes role in researching provider complaints and issues, collaborates with staff from various internal operations areas to determine root causes. Remedies problems, being on point to communicate with providers throughout the course of problem resolution.
• Takes the front-line in establishing and maintaining strong communications with providers. Collaborates with Regional Managers and manages staff and support activities.
• Develops and maintains strategic and tactical approaches to relating to high-impact providers in the network that will distinguish the company in the industry and result in peak provider satisfaction and network stability.
• Establishes and maintains optimal communication channels with client provider relations and account management to foster confidence in the company`s abilities to rapidly resolve provider issues.
• Identifies opportunities for promoting broader use of web services and proactively communicates with providers not taking full advantage of these services to understand why.
• Assists with network strategy committee meeting and network application processing decision committees
• Collaborates and monitors with credentialing teams to ensure provider compliance with provider and state contracts.
• Conducts training sessions for staff: provider relations and call center staff on contract and network management processing and policy in provider and contract management source systems.

Responsibilities

• 5-8 years experience in a Provider Relations role for a managed care plan. 
• Bachelor's degree in a related field, or at least 4 additional years of experience in healthcare, network development, network management.
• Solid knowledge of health plan operations required.
• Depending on assigned business unit, knowledge or experience in management of medical drug benefits, specialty pharmacy, pharmacy benefits management (PBM), behavioral health, or radiology may be required.

Work Experience

Work Experience - Required:

Network

Work Experience - Preferred:

Education

Education - Required:

A Combination of Education and Work Experience May Be Considered., Bachelors

Education - Preferred:

Masters

Certifications

Certifications - Required:

Certifications - Preferred:

Potential pay for this position ranges from $60,800.00 - $97,280.00 based on experience and skills. Pay range may vary by 8% depending on applicant location.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy or related condition (including breastfeeding), expecting or parents-to-be, or any other basis protected by law. 

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.