Full-Time
Client Relationship Manager
Integrated Resources
501-1,000 employees
No salary listed
Harrisburg, PA, USA
In Person
 Operations & Logistics (1) |
|---|
- Bachelor’s degree in business or health related discipline such as Healthcare Administration or Healthcare Management or equivalent business experience required
- Minimum of 5 years provider contracting/reimbursement experience in healthcare setting required
- 1-2 years Medicaid experience required
- Responsible for development and management of provider networks for all products: Medicaid, and Medicare.
- Responsible for hospital and physician network development and management.
- Develops and recommends policy changes related to provider recruitment and contracting.
- Recruits and negotiates contracts with specific providers within operational and potential new counties to meet company requirements.
- Oversees training and communication for network providers and acts as a liaison with the provider community.
- Ensures compliance with pricing guidelines established by AMFC and Plan.
- Ensures provider contracting is consistent with claim payment methodologies.
- Maintains familiarity with Medicare and State Medicaid fee schedules and reimbursement methodologies and analyzes comparable Plan pricing guidelines.
- Resolves difficult complex contract issues to ensure that provider contracts are in compliance with state, federal, national accrediting agencies and Plan contracting guidelines.
- Ensures that non-standard contract elements are communicated to appropriate departments and obtains AMFC and Plan approval prior to submission to provider.
- Responsible for the accuracy and timely management of all provider contracts.
- Responsible for implementation of electronic strategies for provider network to include increasing electronic claims submission and implementation of improved processes that result in increased auto-adjudication of claims.
- Responsible for achievement of quality and health plan objectives through accomplishment of provider initiatives
- Master’s Degree highly preferred.
Company Size
501-1,000
Company Stage
N/A
Total Funding
N/A
Headquarters
Edison, New Jersey
Founded
1996
Simplify's Take
What believers are saying
- Certification boosts appeal to quality-focused healthcare organizations.
- Reskilling programs cut time-to-hire amid workforce shortages.
- Positions IRI among 15,000 Joint Commission-accredited elite firms.
What critics are saying
- Certification lapses in 12-18 months from failed onsite review.
- Patient complaints trigger decertification and client losses in 6-12 months.
- AMN Healthcare captures IRI's mid-sized clients in 12-24 months.
What makes Integrated Resources unique
- Joint Commission Gold Seal certifies IRI's staffing compliance since 2009.
- AI tool Nova hybridizes with reskilling to close healthcare skills gaps.
- Focuses on diversity hiring and performance monitoring for elite placements.
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Benefits
Wellness Program
Mental Health Support
Flexible Work Hours
Phone/Internet Stipend
Home Office Stipend
Conference Attendance Budget
Company News
Edison, New Jersey - Integrated Resources Inc. has earned The Joint Commission's Gold Seal of Approval(R) for Health Care Staffing Services Certification by demonstrating continuous compliance with its performance standards.
Integrated Resources Inc. has earned The Joint Commission’s Gold Seal of Approval ® for Health Care Staffing Services Certification by demonstrating continuous compliance with its performance standards.