NETWORK RELATIONS CONSULTANT SR

Direct Staffing Inc; Rancho Cordova (CA); On-site; USD 55,000 - 75,000; Full time

Job summary

A leading company is seeking a Provider Relations Manager to oversee customer service for contracted providers. This role includes managing outreach, resolving conflicts, and ensuring provider satisfaction. Candidates should possess a BA/BS degree and relevant experience in provider relations or managed care, along with strong communication and problem-solving skills.

Qualifications

• Requires a BA/BS degree.
• 3-4 years of related experience preferred.
• Provider relations, health insurance, or managed care experience preferred.

Responsibilities

• Manage Provider Relations functions and ensure quality customer service.
• Oversee provider outreach and education activities.
• Resolve issues raised by providers to maintain satisfaction.

Skills

Communication Skills

Customer Service Skills

Time Management

Problem Solving

Interpersonal Skills

Education

BA/BS Degree

Tools

Computer Applications

Job description

Manage the Provider Relations functions of ensuring quality customer service and acting as the primary liaison to the Plan's contracted providers to organize and conduct activities to maximize provider retention, interest and loyalty.

Oversee all provider outreach activities to ensure that education for providers and resolution of issues are delivered in an accurate, timely, professional and courteous manner.

Plan, prepare, and present programs, materials and publications to participating providers.

Serve as a primary point of contact and resource to resolve issues raised by, or impacting, the Plan's providers and related support staff.

Intervene with hospitals, physicians and other provider contractors to examine specific policies, procedures, complaints in a manner which yields a positive resolution that meets Plan standards, while maintaining provider satisfaction.

Organize and prepare materials and represent Plan at meetings.

Introduce and mainstream new products and improve and maintain existing products for providers.

Qualifications

Requires a BA/BS degree; 3-4 years of related experience; or any combination of education and experience, which would provide an equivalent background.

Requires excellent communication skills (written and verbal) and interpersonal skills

Must have strong customer service skills, time management and organizational skills

Must be able to communicate effectively to groups and individuals; be proficient orally and in writing to answer questions, training, directly, and/or working cooperatively with other staff to encourage teamwork and productivity.

Will be required to identify, anticipate and solve complex problems, and intervene on behalf of the Plan or a provider to resolve conflicts in a positive manner and to reach an acceptable result.

Must be able to work independently and assume responsibility for the completion of special projects in a timely manner.

Provider Relations experience is preferred

Health Insurance or managed care experience is preferred

Medicaid experience is preferred.

Requires experience navigating computer applications.

Travel to provider offices, hospitals, health fairs may be required

Additional Information

All your information will be kept confidential according to EEO guidelines.

Direct Staffing Inc