Lead and mentor the Service Delivery team in Tier 1 and Tier 2 consulting initiatives, providing education, problem resolution, and client support for health plan operations.
Compensation
The annual US base salary range for this position is $90,000 to $120,000.
Responsibilities
Provide product education to end-users
Conduct scoping sessions to identify client needs
Manage and execute client-facing education services
Escalate and resolve Tier 1 and 2 client issues
Act as liaison between clients and internal teams
Requirements
Bachelor’s degree in a business, health services administration, mathematics, science or related field
The Provider Relations Account Executive fosters and maintains partnerships between the healthcare organization and a network of providers, ensuring seamless communication, addressing concerns, and facilitating contract negotiations.
Responsibilities
Develop and maintain strong collaborative relationships with providers through high-touch communication to ensure network adequacy and quality and other provider performance goals are met.
Facilitate the development, negotiation, and execution of provider contracts, ensuring terms meet regulatory standards and organizational policies.
Monitor provider performance metrics and work with providers to implement corrective action plans when necessary.
Serve as the primary point of contact for all assigned providers, and as a link to various departments to address inquiries, resolve disputes, and maintain positive partnerships.
Maintain accurate records of provider interactions and follow up on outstanding issues to ensure timely resolution.
Requirements
Bachelor’s degree in Healthcare Administration, Business, or a related field
Nice to have: Master’s degree in Healthcare Administration, Business, or a related discipline
Nice to have: Experience working with managed care organizations or health insurance providers
Nice to have: Familiarity with healthcare data analytics and performance measurement tools
Nice to have: Certification in healthcare management or provider relations
The Provider Relations Account Executive fosters and maintains strong partnerships between the healthcare organization and a network of providers, managing communication, contracts, and network growth.
Responsibilities
Develop and maintain strong collaborative relationships with providers
Facilitate the development, negotiation, and execution of provider contracts
Monitor provider performance metrics
Serve as the primary point of contact for all assigned providers
Maintain accurate records of provider interactions
Requirements
Bachelor’s degree in Healthcare Administration, Business, or a related field
Nice to have: Master’s degree in Healthcare Administration or Business
Nice to have: experience working with managed care organizations
The Provider Relations Account Executive plays an essential role in fostering and maintaining strong partnerships between our healthcare organization and a diverse network of providers, ensuring seamless communication, addressing provider concerns, and facilitating contract negotiations.
Responsibilities
Develop and maintain strong collaborative relationships with providers through high-touch communication to ensure network adequacy and quality and other provider performance goals are met.
Facilitate the development, negotiation, and execution of provider contracts, ensuring terms meet regulatory standards and organizational policies.
Monitor provider performance metrics and work with providers to implement corrective action plans when necessary.
Serve as the primary point of contact for all assigned providers, and as a link to various departments to address inquiries, resolve disputes, and maintain positive partnerships.
Maintain accurate records of provider interactions and follow up on outstanding issues to ensure timely resolution.
Requirements
Bachelor’s degree in Healthcare Administration, Business, or a related field
Nice to have: Master’s degree in Healthcare Administration, Business, or a related discipline
Nice to have: experience working with managed care organizations
Nice to have: health insurance providers
Nice to have: healthcare data analytics
Skills
Behavioral Health Network Relations Manager – Louisiana
The typical pay range for this role is:
$54,300.00 - $119,340.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Responsibilities
Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships.
Monitors service capabilities and collaborates cross-functionally to ensure that the needs of constituents are met and that escalated issues related but not limited to, claims payment, contract interpretation or parameters, and accuracy of provider contract or demographic information are resolved.
Supports or assists with operational activities that may include, but are not limited to, database management, and contract coordination.
Performs credentialing support activities as needed.
Educates Medicaid providers as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, policies, and procedures.
Manages the physician network by developing and maintaining the assigned IPA/Medical Group, providing service and education to network physicians/providers, and achieving company targets through network improvement plans.
Responsibilities
Completes new provider orientation for all applicable product lines.
Conducts provider group meetings to review monthly/quarterly data and outcomes.
Responsible for meeting minutes and follow-up on 'TO DO' items identified at meetings.
Conduct site visits to service providers, resolve issues, educate staff and providers on policies, and collect credentialing information.
Conduct site visits to service providers and educate staff and providers on submitting Risk Adjustment Factor Data and HEDIS information.
Requirements
Bachelor's Degree in Marketing or Business Administration
Business Development Associate who lives in Florida to expand access to behavioral healthcare by building and strengthening relationships with healthcare organizations and referral partners across the state of Florida.
Responsibilities
Grow Referral Partnerships
Develop strategies to grow existing partnerships and build new referral relationships
Identify high-potential providers, practices, specialties, and healthcare organizations within assigned markets
Use referral and account data to prioritize outreach, identify opportunities, and re-engage declining or inactive partners
Build Healthcare Relationships
Requirements
Bachelor’s degree in Business, Healthcare, Marketing, Communications, or a related field
Provider Relations Account ExecutiveIndependent Living Systems · Tallahassee, US