Overview Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 45 hospitals and has more than 300 outpatient locations in 14 states providing more than 2.6 million patient visits annually. It is one of the nation’s leading health systems with nearly 50,000 employees and physicians. Fourteen of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team! Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC\_KnowYourRights\_screen\_reader\_10\_20.pdf Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf Responsibilities Responsible for running the EPO call center, day to day operations, daily intake of members, providers, and others. Supervise coaching, training, and evaluating staff as they provide support for customers. Preparing reports and analyzing call center data to improve processes, ensure resources are properly allocated, and maximize efficiency and customer satisfaction. Under the supervision of the Director of Provider and Member Relations, the Provider and Member Relations Manager is responsible for the oversight and direction of the Customer Services Representatives activities and personnel, assisting in the development of internal and external P&P, developing meaningful reports for use in JOM, ensuring the resolution of Member and Provider cases assigned to the PSR Team, interfacing with multiple departments to address Provider related concerns and motivating Team Members. Major Functions. Qualifications EDUCATION, EXPERIENCE, TRAINING Required qualifications: 1. Bachelor’s degree in healthcare, Business, Computer Science, or IT related field.2. Knowledge of medical claims, appeals, and grievances, and member and provider relations.3. Strong customer service, oral and written communication skills.4. Excellent communication, organizational, and analytical skills.5. Strong computer skills including MS Office skills.6. 5+ years of experience in customer service and provider relations in a health care or managed care environment.7. Excellent interpersonal skills and solid communication with all levels of management.8. Able to multitask, prioritize, and manage time efficiently.9. Experience handling a high call volume in a professional and courteous manner.10. Working knowledge of self-funded medical plans and/or Managed Care plans.11. Supervise staff, schedule work hours, run production reports to monitor unit activities and quality. Preferred qualifications: 1. Previous management experience including responsibilities for hiring, training, assigning work, and managing performance of staff.2. Strong interpersonal and collaborative skills.3. Demonstrated experience and knowledge of contracting requirements.4. Experience working in a consensus building and matrix environments a plus.5. Previous health plan and provider representative experience preferred. Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. Benefits may vary based on employment status, i.e. full-time, part-time, per diem or temporary. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $71,760.00 to $107,640.00 on an annualized basis. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/186850/provider-and-member-relations-manager/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime Healthcare Management Inc LocationUS-CA-Ontario ID2024-186850 CategoryManager Position TypeFull Time ShiftDays Job TypeExempt