Manager, Provider Relations

Company: McLaren Health Plan
Location: Flint
Posted on: May 15, 2022

Job Description:

Mgr Provider Relations MI - (22003209)
McLaren Health Plan, a division of McLaren Health Care Corporation, is a company with a culture of high performance and a mission to help people live healthier and more satisfying lives. We are looking for a Manager, Provider Relations to join in leading the organization forward.McLaren Health Plan (MHP) is a Managed Care Organization dedicated to meeting the health care needs of each member. MHP and its subsidiaries offer multiple product lines, including employer plans, individual and family plans, Medicaid and Medicare plans, to Michigan residents for every stage of life. The plan has earned the prestigious Pinnacle Award every year since 2013 from the Michigan Association of Health Plans and is also accredited by the National Committee for Quality Assurance (NCQA).With a commitment to diversity and inclusion, a strong focus on improving the health of our members and a vision to provide the highest standards of quality and service, MHP is poised to meet the challenges of tomorrow.
Position Summary:Responsible for the planning, managing, and organizing Provider Relations functions for all products as designated. Responsible for developing a robust provider network, in conjunction with senior staff, including negotiating and contracting with providers. Responsibility for tracking and managing Provider Relations activity, including staff and performance reviews, provider education, and day-to-day operations of the department. Professionally and effectively markets the advantages of being a Plan network provider to prospective providers. Generates new contracting opportunities through telemarketing, written communications, and other distribution channels. Develop and implement processes to monitor contractual obligations and ensure the Plan's compliance with such. Maintains regulatory compliance with State regulators and accrediting agencies. Responsible for the identification, research, reporting, and elimination of fraud and abuse. Responsible for analyzing, development and implementation of education and training programs for contracted providers and their staff. Designs, implements, and adjusts workflows to ensure department efficiencies are maintained.
Required:

• Bachelor's Degree in business, health care or related field.
• Five (5) years' progressive experience in a leadership role with a minimum of three (3) years in a supervisory role leading a professional staff of five or more members in all phases of effective supervision (i.e. Recruitment, performance management, training).
• Three (3) years' experience in a managed care organization with specific responsibilities in provider relations and contracting; including demonstrated success in leading negotiations.
• Must have a valid driver's license and use of a personal vehicle for travel.Preferred:
  • Seven (7) years' experience and knowledge of HMO, PPO, TPA, PHO and Managed Care functions (e.g.
  • Five (5) years' experience in Provider contracting; including demonstrated success in leading negotiations.Equal Opportunity Employer of Minorities/Females/Disabled/Veterans
    Primary Location Michigan-Flint-McLaren Health Plan BldgWork Locations McLaren Health Plan Bldg G3245 Beecher Rd Flint 48532Job ManagerOrganization McLaren Health PlanEmployee Status RegularJob Type StandardSchedule Full-timeShift Day JobOn Call NoWeekends No

Keywords: McLaren Health Plan, Flint , Manager, Provider Relations, Executive , Flint, Michigan