Senior Provider Relations Representative

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. Primary liaison between the client and MSO for the delivery of Managed Care Administrative Services. Responsible for concise and complete explanations of all phases of services from each MSO Department to the assigned IPA groups and resolving issues between them. Also responsible for identifying process improvement opportunities and supporting long‑term relationship management strategies with provider groups. Primary Responsibilities: Coordinates and conducts meetings within assigned territory. Maintains official copies of minutes, agendas and credentialing signatures at the MSO's office. Sends announcements regarding scheduled meetings, makes phone calls to verify attendance (quorum), orders refreshments and sets up/breaks down the meetings. Prepares, or directs the preparation of, agendas, handouts and meeting minutes. Represents management at all meetings with clients in an appropriate and professional manner Serves as a resource for internal referrals on provider issues. Supports the Client Services Department in resolving provider issues and responds to training needs identified by other MSO departments such as Claims and Medical Management. Interfaces with Health Plan staff as required. Effectively problem solves issues as identified; documents all contact with providers/office staff in the provider's file. Monitors client needs to evaluate satisfaction levels, and identifies trends and areas requiring improvement. Identifies recurring issues and collaborates with teams to refine training content and improve cross‑departmental processes Manages the interface between providers, the MSO and the health plans. Remains accessible to providers and their office staff. Leaves specific instructions about how to be reached within and outside the office. Utilizes email and the cell phone to maintain productivity within and outside the office. Schedules regular visits with physician offices to provide education, training and customer service. Establishes and maintains strong, productive relationships with office staff by providing superior customer service and effectively solving issues. Stays current with activities in the market by developing an open rapport with the offices. Represents management at all meetings with clients in an appropriate and professional manner. Collaborates with leadership to prioritize high‑impact providers and proactively address network challenges Recruits providers in designated geographic areas, negotiates provider contracts within specified guidelines and assists the Director of Network Management in all phases of network negotiations and contracting. Investigates interested providers for consideration by the regional committee. Notifies health plans and appropriate internal departments of provider contract and status changes. Functions as a messenger between plans and IPA clients, as applicable, during contracting functions Develops provider manuals, provider directories, provider communications, and other related materials; and facilitates the distribution of such information Provides feedback and recommends updates to materials to ensure clarity, consistency, and alignment with regulatory changes Internet portal user set‑up, training, documentation, communication and troubleshooting with vendors as necessary. Monitors common user issues and collaborates with IT to improve portal functionality and user experience Completes other duties as requested and assigned. May participate in cross‑functional initiatives or special projects to support department and organizational goals You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: 5+ years of experience in managed care Proven experience in managed care operations Experience training individuals on managed care policies and procedures in small or large groups. Presentation skills Experience organizing meetings and taking minutes. Ability to conduct on‑line meetings and conference calls Knowledge of CPT, ICD‑9 Codes Adept in interpreting contract language, rates, and coverage definitions Ability to communicate in a professional manner, have problem solving skills and work independently Excellent organizational and interpersonal skills Ability to work effectively with a wide variety of people at all levels Computer literacy, including competence with various word processing and managed care programs. Microsoft Office familiarity Reliable transportation, valid California Driver's License and proof of insurance Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 to $130,000 annually based on full‑time employment. We comply with all minimum wage laws as applicable. OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. OptumCare is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment. #J-18808-Ljbffr Optum