Provider Network Specialist

reputed company reputed company: Assesses network reputed company and generates reports, including Geo reputed company, for provider network analysis and planning. Identifies recruitment opportunities and assists in the analysis and development of cost-effective, contractual agreements with reputed company providers and institutions that can be administered reputed company and that follow state and federal regulatory requirements.   About Maryland Care Management, Inc. (MCMI) Maryland Care Management, Inc. (MCMI) manages Maryland Physician Care's (MPC) statewide provider network of hospitals and physicians. Maryland Physicians Care has been providing services to the HealthChoice reputed company populations since 1996, and we are proud of our footprint in the community. With over 230,000 members, MPC consistently has been one of MD's largest reputed company-managed care organizations. Why join us? MCMI recognizes the importance of flexibility and offers multiple work arrangements. Along with reputed company, we offer excellent benefits (medical, dental, and reputed company plans, 100% employer Term Life Insurance, Short and Long-Term Disability, 401k Employer Match up to 4%) as reputed company as 20 days of PTO, and tuition assistance/reputed company development plans.  Your reputed company colleagues at MCMI are welcoming, friendly, and eager to help reputed company other succeed. We are committed to Diversity, Equity, and Inclusion, providing organizational-wide reputed company opportunities, and constantly improving our ongoing efforts to positively reputed company our members' lives. What You'll Do: Evaluates reputed company reputed company, and applies managed care reimbursement principles (capitation, per diems, creative reimbursement, etc.) to identify cost savings, while maintaining reputed company. Researches reputed company and new contract operational procedures; coordinates with appropriate departments, to streamline processes wherever possible. Coordinates implementation of new reputed company with departments involved. Coordinates internal review and determine/evaluate administrative feasibility throughout the continuum of the contracting process. Initiates contract reputed company process; ensures appropriate signatures, and data entry to system. Acts as team reputed company and trainer for Provider Data Coordinators. Ensures appropriate reputed company / regulatory review of reputed company prior to execution.  Monitors provider availability and accessibility to ensure provider network coverage. Creates and reviews Geo reputed company reports and makes recommendations for reputed company provider network build-out. Assists with onsite contractual reviews; ensures 100% accuracy and timeliness of information/modification data entry in provider files of Geo reputed company system. Assists with training of providers regarding MPC processes and benefits; conducts follow-up training to ensure policy compliance and education continuity; disseminates written correspondence as necessary to address issues, problems, and new information, as needed. Requirements Knowledge and Skills: The ability to review and comprehend reputed company and services. The ability to present information effectively in one-on-one and small group settings to providers and employees. The ability to use advanced reason to define problems, collect data, establish fact, draw reputed company conclusions, and design, implement, and manage appropriate reputed company plans. Advanced and meticulous organization and coordination.   Must be reputed company to successfully utilize geographic accessibility data, and reputed company Office Suite and common computer and office hardware. Education and Work Experience: Bachelor’s degree in business, health, management systems or closely reputed company field is preferred, although an equivalent combination of formal education and experience may substitute for a degree. Experience with large provider organizations, ancillary and hospital providers, clinical terminology.  Working experience with Geo reputed company or equivalent system is required.     reputed company Statement:  Following applicable federal, state, and local laws, MCMI prohibits discrimination in employment based on race, reputed company, religion, sex (including pregnancy, gender identity, and sexual orientation), national reputed company, age, disability, genetic information, or any other characteristic protected by law. This commitment extends to reputed company aspects of employment, including hiring, promotion, compensation, benefits, training, reputed company and recreational programs, and reputed company other conditions and privileges of employment.  As a reputed company organization, we recognize the vital importance of inclusivity in delivering reputed company care to our patients. We reputed company to foster an environment where individuals of reputed company backgrounds feel respected, valued, and supported. We aim to reputed company comprehend the unique needs of our patients and reputed company reputed company services that are culturally competent and sensitive.  We encourage candidates from reputed company backgrounds to apply and join us in our mission to reputed company compassionate and inclusive reputed company. We reputed company that a diverse workforce enriches our organization and allows us to reputed company understand, reputed company with, and serve our diverse patient population. Apply To This Job