CorVel Corporation · 1 day ago

Provider Network Manager

Rancho Cucamonga, CA

Full-time

Remote

Mid, Senior Level

$80K/yr - $133K/yr

5+ years exp

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Responsibilities

Ensures ancillary vendor and provider contracted provider and vendor rates meet corporate requirements and goals; holds account for national contracts’ impact on direct expenses and subsequent product profitability, while maintaining strong relationships with vendor/provider representatives.

Collaborates with local stake holders to improve nationwide and state-by-state networking strategy, contracted rates and outcomes as needed.

Manages operational and business requirements language utilized in ancillary provider and vendor contracts.

Reviews and evaluate Facility contract language and rates annually, makes necessary changes in collaboration with all impacted stakeholders, internal and external.

Identifies National contract opportunities and qualifies potential participants and client nominations.

Builds familiarity with Workers’ Compensation, Auto insurance and Group Health rules and regulations relating to the ability to channel patients, reimbursement schedules, PPO reduction limitations, and etc.

Works with CorVel Provider Relations staff in educating providers on CareIQ program rules and regulations, contract terminology, and service expectations from participating provider and vendor groups.

Conducts training calls and impromptu individual training meetings as needed.

Identifies provider network coverage and service deficiencies and owns the resolution strategy and implementation.

Manages National provider issues to completion.

Manages National Network projects and resolutions.

Manages Network contracts through legal review and approval process.

Manages National contracts under legal challenge and/or arbitration unto resolution.

Additional duties as assigned.

Qualification

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Vendor managementPPO network contractingProvider network managementMicrosoft applicationsContract managementHealthcare managementTraining skillsWorkers’ Compensation knowledge