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Contracting & Network Development Specialist

4 months ago

Hialeah, United States ClareMedica Health Partners LLC Full time
Job DescriptionJob DescriptionDescription:

Network Development Specialist

Location: Corporate -Hybrid Classification: FT Non-Exempt

Department: Clinical Operations Reports to: Department Administrator

Position Category: Non- Managerial Last Revised: September 2023

At ClareMedica, exceptional is the standard.

Driven by our purpose to enhance the lives of the seniors in the communities where we have the privilege to work, live, and play, the ClareMedica team is comprised of the brightest and best in their fields of expertise. From clinical excellence to unparalleled administrative support and beyond, we’re working together to help seniors live happier, healthier, fuller lives.

That kind of teamwork and passion for excelling can only exist in a workplace that fosters employees’ growth and wellness and where their full potential and value are realized. At ClareMedica, we’re excited about great people like you. We’re even more excited to support you with the resources, training, benefits, competitive compensation, and more to help you thrive and succeed in our communities.

Opportunity awaits – welcome to ClareMedica.

ESSENTIAL FUNCTIONS:

The Network Development Specialist recruits and contracts with healthcare providers to strengthen and expand the organization's network, ensuring access to quality healthcare services.

DUTIES AND RESPONSIBILITIES:

  • Identify and recruit healthcare providers and facilities to expand the organization's network.
  • Foster positive relationships with existing and potential network providers.
  • Manage contracts to ensure favorable terms and compliance with regulatory requirements.
  • Implement strategic plans to enhance the network's reach and quality of services.
  • Collaborate with cross-functional teams to align network development efforts with organizational goals and objectives.
  • Analyze network data and performance metrics to identify areas for improvement.
  • Review referral requests to ensure providers are contracted and in-network.
  • Communicate the preferred provider list to facilities as necessary.
  • Prepare reports as requested by management.
  • Regularly travel to various facilities as needed.

QUALIFICATIONS/REQUIREMENTS

• Knowledge of computer programs

• Familiarity with Availity system

• Ability to operate a computer and basic office equipment

• Knowledge of ICD coding and HEDIS measures

• Knowledge of HMO and medical terminology

• Maintain effective working relationships

• Strong organization, oral/written communication skills

• Own transportation between facilities required

WORKING CONDITIONS

General office working conditions.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

While performing the duties of this job, the employee will be required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs, balance; stoop, kneel, crouch or crawl; talk or hear. The employee must occasionally lift and or move up to 15 pounds. Specific vision abilities required by the job include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust to focus. Manual dexterity required to use desktop computer and peripherals. Exposure to variable weather conditions is likely.

WORK ENVIRONMENT

Work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of his job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.

TRAVEL

Travel is primarily local during the business day, although some out-of-area and overnight travel may be expected.

SAFETY HAZARD OF THE JOB

Minimal Hazards

This job description does not list all duties and responsibilities of the job. You may be asked by supervisors or managers to perform other instruction, duties, and responsibilities, as appropriate. You will be evaluated in part based upon your performance of the duties and responsibilities identified in this job description.

Management has the right to revise this job description at any time. The job description is not a contract for employment, an either you or the employer may terminate employment any time, with or without cause.


Requirements: