Provider Relations Specialist - Utilization Management Admin - Sharp Copley - Day Shift - Full Time

Sharp Healthcare-posted 8 months ago
$31,700 - $47,540/Yr
Full-time
Hospitals
Resume
Match Score
Upload and Match ResumeTrack Jobs with Teal

The Provider Relations Specialist is responsible for the development and maintenance of positive working relationships with all partners, by collaborating on complex organizational initiatives across the integrated delivery system. Provides the connection and partnership between the subcontracted providers, subcontracted services and SRS Medical Group (SRSMG).

  • Primary liaison between SRSMG and health plan provider network, promoting positive relationships between the medical group and the health plans.
  • Work with Quality Department to follow up on quality issues with providers' offices.
  • Research and resolve incoming escalated provider inquiries within specified guidelines and educate providers on new protocols, policies, and procedures.
  • Ensure provider contracting policies are adhered to as related to standard contract language.
  • Routinely visit various locations to ensure that a good partnership is maintained and credentialing requirements and quality standards are being monitored effectively.
  • Maintain an understanding of basic managed care concepts and principles including Managed Care, Medicare, Commercial HMO/PPO benefit programs.
  • Communicate effectively and efficiently both verbally and in writing with providers, peers, patients, and others about day-to-day issues and concerns.
  • Coordinate and ensure the completion of necessary site visits, monitoring the quality of care being provided by the service/provider.
  • Provide leadership with updates on any variances or trends that could impact service delivery.
  • Compile comprehensive summaries for the recredentialing of health care providers.
  • Provide ongoing service/problem solving assistance to providers or health plans as needed.
  • Communicate and validate provider demographics to comply with the Health Plan's regulations and compliance with state insurance regulations.
  • H.S. Diploma or Equivalent
  • 4 Years experience in the health care field with particular emphasis on physician network, physician services, and physician recruitment.
  • Driver's License - CA Department of Motor Vehicles - REQUIRED
  • Bachelor's Degree in Business, marketing, or health care management.
Track Jobs with Teal

Job Search Resources

•
Resume Builder
•
Resume Examples
•
Cover Letter Examples

Tools

Career Hubs

Guides

Company

© 2024 Teal Labs, Inc
Privacy PolicyTerms of Service