Provider Network Manager

1 month ago

Campbell, United States Insight Global Full time

GENERAL SUMMARY OF DUTIES:

The Manager of Network Management and Member Services is responsible for overseeing the operational activities of the Network Management and Member Services departments

What you will do:

  • Supervises a staff consisting of Network Management Associates both in house and remotely, and a Network Management Coordinator whose primary function is to provide provider support/education and interaction with contracted Health Plans (HMO and PPO)
  • Responsible for managing network provider education of applicable policies and procedures
  • Responsible for supervising daily provider inquiries, including capitation and reimbursement issues
  • Assist in development of physician communication programs and strategy
  • Responsible for maintaining strong relationships with contracted Health Plans (HMO and PPO) Communicates with payors and network providers, both orally and written, in association with operational and contractual related issues
  • Oversees client related projects
  • Assist in identifying issues, problems, and areas where performance could be improved
  • Represent organization at physicians’ offices, contracted health plans, and committees when necessary
  • Develop and present educational pieces at network provider meetings
  • Primary responsibility for periodic statistical performance reporting of Network Mgt activities
  • Insure adequate physician network retention, expansion and recruitment
  • Assist with the development of strategic plans for servicing network physicians and members
  • Develop, recommend, and implement new policies and procedures when appropriate

What you will need:

  • Advanced knowledge of managed care market, strategies, and physician compensation models
  • Working knowledge of medical group/IPA operations
  • Excellent verbal and written communication skills
  • Excellent public speaking and interpersonal skills
  • Able to present oneself professionally and have the ability to address large groups of people in educational forums
  • Strong research and analytical skills
  • Able to research complex contractual documents for interpretive purpose and utilize critical thinking skills
  • Willingness to travel locally
  • Knowledge of claims payment systems
  • Possess excellent problem-solving skills and is able to identify and adapt to shifting priorities

Education:

  • Bachelor’s degree in business, health care or related field, or equivalent experience required

Experience:

  • Four to Five years in health care setting, including progressively more responsible experience in a physician office management or physician relations capacity required
  • One to Two years of experience as a manager or supervisor of a department staff

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