Manager, Network Development

4 weeks ago

Rancho Cucamonga, United States Inland Empire Health Plan Full time

Overview:

What you can expect

Find joy in serving others with IEHP We welcome you to join us in healing and inspiring the human spirit and to pivot from a job opportunity to an authentic experience

Under the direction of the Director of Provider Network, the Network Development Manager is responsible for the successful screening and assessment of potential network Providers. The Network Development Manager is responsible for ensuring the successful onboarding of Providers that will aid IEHP in addressing concerns around network adequacy. In this role, the Manager will lead a team that is responsible for maintaining a list of high priority specialties, collaborate with leaders in prioritizing the onboarding of the needed specialties, and remove any barriers that delay the onboarding of Providers addressing network gaps. The Manager will also be responsible for supporting our recredentialing efforts by ensuring IEHP does not lose any Providers that will create a gap in our network. To accomplish this, the Manager must have the ability to build strong internal and external relationships while driving for operational effectiveness that support IEHPs strategic initiatives. The Network Development Manager must have experience in cross-functional business units, Medicare, Medi-Cal, and Covered California lines of business requirements, organizational design, and business process improvement methods. This Manager will work closely with the Provider Network Manager and Credentialing Manager to develop and implement network strategies for recruitment and retention of physicians to aid IEHP in meeting network adequacy requirements.

Key Responsibilities

1. Analyze and develop business plans to include the scope, oversight, and coordination of resources related to the onboarding of new Providers and retention of existing network Providers.
2. Lead in the successful intake, assessment, decisioning of potential network Providers. The Manager must be able to effectively oversee the end-to-end process of onboarding a Provider. If there are delays, the Manager should be able to properly assess the current state, identify the root-cause of the problem, and lead the team in developing solutions to deliver the desired result.
3. Create transparency around the onboarding process to reduce unnecessary hand-offs and friction with our network partners.
4. Manage the fiscal, legal, and external resources to develop and implement strategies to successfully onboard needed Providers.
5. While the onboarding of needed specialties is an integral part of this role, the Manager will also be responsible for collaborating with the Credentialing Manager on Provider retention. The Manager will lead a team to identify the associated risks for specific Providers not meeting recredentialing compliance standards.
6. In collaboration with the Healthcare Informatics team, lead the team in reviewing utilization of out-of-network Providers and determine what course of action is needed to bring these Providers in-network.
7. Responsible for providing technical and business support of Lean efforts, including administrative activities and reporting. Work with the Director of Provider Network on process improvement and regulatory process change projects.
8. Provide support to LEAN initiatives as technical subject matter expert in ensuring LEAN activities in all Provider Services departments have appropriate reporting and data collection to ensure successful outcomes.
9. Assist in facilitating and coordinating all Provider Incentive Programs, including those with IPAs and Providers.
10. Responsible for maintaining comprehensive knowledge of regulatory and IEHP requirements including IEHP policies and procedures, reporting requirements, DOFR, IPA reporting requirements related to delegation oversight and IPA delegated activities.
11. Lead, monitor, and maintain a detailed project plans that identify all required tasks, deliverables, and associated timelines. Define project success criteria, identify concerns; report and communicate project status to Management as appropriate.

Additional Benefits:

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.

  • CalPERS retirement
  • 457(b) option with a contribution match
  • Generous paid time off- vacation, holidays, sick
  • State of the art fitness center on-site
  • Medical Insurance with Dental and Vision
  • Paid life insurance for employees with additional options
  • Short-term, and long-term disability options
  • Pet care insurance
  • Flexible Spending Account Health Care/Childcare
  • Wellness programs that promote a healthy work-life balance
  • Career advancement opportunities and professional development
  • Competitive salary with annual merit increase
  • Team bonus opportunities


Qualifications:

Education & Experience

  • At least three (3) years of experience with direct responsibilities for project management, including assigning, tracking, and monitoring project tasks. Evidence of leading workgroups in meeting prescribed deliverables.
  • Experience in a healthcare setting is preferred. Experience in an HMO, managed care, knowledge in Medi-Cal and Medicare programs preferred.
  • Bachelor's degree from an accredited institution required.

Key Qualifications

  • Strong understanding of process development and oversight.
  • Strong organizational skills.
  • Proficient in Microsoft Office applications.
  • Strong written and oral communication skills.
  • Strong organizational skills and sound decision-making skills required.
  • Skilled in writing policies and procedures, developing business plans and LEAN related documentation and metrics.
  • Must be detail oriented.
  • Exceptional follow-through abilities to track all outstanding tasks and coordinate with assigned owners to ensure tasks are completed timely.
  • Ability to manage multiple projects of varying complexity, priority levels and deadlines.
  • Ability to critically review data and implement operational recommendations.
  • Highly organized to balance multiple projects to meet deadlines.
  • Highly organized with the ability to balance multiple projects and meet deadlines.
  • Ability to work independently with the ability to develop concepts and business operations.

Start your journey towards a thriving future with IEHP and apply TODAY

Work Model Location:

Hybrid

Pay Range:
USD $57.02 - USD $75.55 /Hr.

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