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Carle Foundation Hospital Manager of Provider Relations - FCC in Urbana, Illinois

Manager of Provider Relations - FCC

  • Department:

FirstCarolinaCare

  • Entity:

First Carolina Care

  • Job Category:

Management

  • Employment Type:

Full - Time

  • Job ID:

16531

  • Experience Required:

3 - 5 Years

  • Education Required:

Bachelors Degree

  • Shift:

Day

  • Location:

Pinehurst, NC

  • Usual Schedule:

8:00 -5:00; M-F

  • On Call Requirements:

n/a

  • Work Location:

FCC - Pinehurst

  • Secondary Job Category:

Insurance

  • Weekend Requirements:

n/a

  • Holiday Requirements:

n/a

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Position Summary:

Posting Closing date 5/8/2021 The Manager of Provider Relations is responsible for coordinating and managing the provider contracting, recruitment and retention efforts of FCC. Ensures adequate network development of physician, hospital and ancillary networks to serve the needs of the current and projected membership of FCC. Assures compliance with regulatory, statutory and accreditation organizations. Responsible for oversight of other networks FCC contracts with to ensure compliance and handle all member issues for access to the networks. Accountable for customer service to ensure staffing and training needs of FCC are met and assist COO with oversight of vendors providing customer service. Management duties include hiring, training, coaching, counseling, and evaluating performance of direct reports.

Qualifications:

Education: Bachelors degree or equalivant expereince. Experience: Four to six years of insurance experience preferably in a managed care organization, integrated life and health company or related healthcare organization; also prefer a working knowledge of physician practice management including claims processing and provider contracting.

Essential Functions:

  • Uses an appropriate problem-solving approach to plan services.

  • Coordination and focus on developing product awareness in the provider market

  • Participate in establishing adequacy standards setting appropriate network goals

  • Carry out day-to-day activities as delineated in annual strategic plan

  • Participate in establishing budgets and measurable indicators

  • Assist in the development of communication materials, collateral materials and publications

  • Develops and coordinates program to benchmark departmental performance against appropriate regional and national norms, consistent with FirstHealth philosophy

  • Analyzes financial impact of fee changes and market share shifts

  • Works with actuary on fee schedule comparisons to ensure competitiveness in market

  • Participate with development of rates, benefits offerings and other financial aspects of the client sale

  • Assists medical staff in communicating policies to providers and ensuring compliance with medical management rules

  • Works with and reviews all provider related inquiries to ensure provider issues are resolved timely and accurately

  • Develop the necessary processes to carry out activities to successfully achieve the goals of FirstCarolinaCare and FirstHealth and perform all duties assigned by management

  • Plans, manages and coordinates provider department activities

  • Provides analyses, reporting and support of organizational process and activities to FCC management

  • Assures that contracting activities are in compliance with regulatory statues and corporate policies

  • Provides consulting assistance to providers as necessary to assist in improving their operations resulting in improved satisfaction with FCC systesm

  • Assures appropriate educational activities are made available to individual providers and provider organizations

  • Assures compliance with database management requirements of FCC and corporate organization.

  • In coordination with the Compliance Officer, advises employees, management, medical staff and Board in situations involving actual or potential non-compliance activities

  • Develops and implements educational programs concerning issues relevant to management and providers

  • Ensures staff is trained and audits work

  • Assists with training staff at vendor sites and auditing of their work

  • Participates in internal training of FCC staff at all levels

  • Prepares reports as required by various agencies and FirstCarolinaCare management

  • Maintains appropriate files and records for areas of responsibility

  • Facilitates or prepares all provider communications and provider manuals

  • Ensures policies and procedures are updated timely

  • Prepares and submits all required regulatory reports requiring input on provider network data

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

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