Lead Provider Network Specialist PACE

6 days ago

Murrieta, California, United States Neighborhood Healthcare Full time
Job Summary

We are seeking a highly skilled Lead Provider Network Specialist to join our team at Neighborhood Healthcare. As a key member of our PACE program, you will be responsible for guiding strategic growth and expansion of our specialty network. This role involves managing, overseeing, and enhancing all contractual relationships with our community providers, support services, and administrative contractors.

Key Responsibilities:

  • Liaison and Oversight: Act as the primary liaison to oversee all Contracted Network Services Agreements, collaborating with NHC PACE Contracted Providers and Service Entities (Administrative & Support).
  • Research and Interaction: Conduct thorough research on issues and interact with the Neighborhood PACE operations team to facilitate effective processes.
  • Specialist Recruitment: Partner closely with the NHC PACE Medical Director to recruit qualified specialist physicians to serve as contracted services.
  • Hospital and Facility Alignment: Work with the NHC PACE Medical Director and NHC Contracts Specialist to align qualified and accessible hospitals, skilled nursing facilities (SNFs), and nursing homes as network contracted.
  • Contractor Services Matrix: Utilize the NHC PACE Contracted Providers Matrix to ensure all required PACE Contractor services have contracted.
  • Database Management: Ensure the collection and entry of all required information into the Contracted Services database for proper tracking, compliance monitoring, and reporting.
  • Annual Reviews and Training: Utilize weekly reports to contact contractors to schedule annual PACE Competency Reviews, Training Sessions, and Contract renewals.
  • Compliance Monitoring: Maintain and share reports with the NHC Medical Director on any pending or overdue compliance or contract renewals needing attention.
  • Contract Coordination: Work with NHC PACE contractors to coordinate contracting terms and activities between the contractors and NHC.
  • Request Management: Monitor and maintain incoming contract requests from the PACE operations team and close out any requests within the appropriate timeframe.
  • Credentialing Coordination: Collaborate with the Credentialing Team in Revenue Cycle to coordinate the credentialing process, ensuring compliance with CMS and DHCS requirements.
  • Primary Source Verification: Verify elements related to an applicant's legal authority to practice, relevant training, experience, and competency from the primary source during the credentialing process.
  • Ongoing Compliance Monitoring: Collaborate with the PACE Compliance Officer for ongoing monitoring to ensure continued compliance with credentialing standards and assess contractor occurrences for substandard professional conduct and compliance.
  • Provider Application Management: Review the NHC PACE website daily to gather and process interested provider applicant information and intake provider application interest and status.
  • Rate Setting Development: Work closely with the NHC PACE Finance Director to develop and derive PACE rate setting standards per contractor type, ensuring alignment with PACE, managed care, and/or NPA.
  • Best Payment Practices: Research and confirm best contractor payment practices for NHC PACE.
  • Contract Preparation: Collaborate with NHC Contracting team for final approval and signature of all PACE contracts.
  • Annual Compliance Verification: Utilize the Oversight Compliance Checklist to verify annual compliance for each NHC PACE Provider and Administrative/Support.
  • Confidentiality Compliance: Work closely with the NHC PACE HIPAA Privacy Officer to ensure confidentiality and compliance with all regulations regarding corporate integrity and security obligations.
  • Patient and Employee Engagement: Respond promptly and with care to patients and employees, acknowledging and honoring psychosocial, spiritual, and cultural differences.
  • Professional Relationships: Maintain professional working relationships with all levels of staff, clients, and contractors.
  • Team Collaboration: Be part of a team and cooperate in accomplishing department goals and objectives.

Requirements:

  • Bachelor's degree or equivalent combination of education and experience.
  • Valid CA driver's license and valid auto insurance.
  • Minimum of 5-7 years of experience in contracting on behalf of or with health care providers or plans in a managed care setting.
  • 5+ years' experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types.

Additional Qualifications:

  • Excellent verbal and written communication skills, including superior composition, typing, and proofreading skills.
  • Ability to interpret a variety of instructions in written, oral, diagram, or schedule form.
  • Knowledgeable about and experience with contracts.
  • Ability to successfully manage multiple tasks simultaneously.
  • Excellent planning and organizational ability.
  • Ability to work as part of a team as well as independently.
  • Ability to work with highly confidential information in a professional and ethical manner.

Physical Requirements:

  • Ability to lift/carry 15 lbs./weight.
  • Ability to stand for long periods of time.

Compliance (Safety & HIPAA):

  • Follows all safety procedures as outlined in Neighborhood Healthcare's Illness and Injury Prevention Plan (IIPP) and report any injuries and/or unsafe conditions immediately.
  • Maintains current knowledge of policies and procedures as they relate to safe work practices.
  • Follows all safety procedures and report unsafe conditions.
  • Uses appropriate body mechanics to ensure an injury-free environment.
  • Familiarity with location of nearest fire extinguisher and emergency exits.
  • Follows all infection control procedures including blood-borne pathogen protocols.
  • Maintains privacy of all patients, employee, and volunteer information and access such information only on a need-to-know basis for business purposes.
  • Complies with all regulations regarding corporate integrity and security obligations.
  • Reports all behavior and/or activity that are unethical, fraudulent, or unlawful.

Benefits:

Neighborhood Healthcare offers a generous benefit plan that includes: Partially company-paid Medical, Dental, and Vision Plans. Two plus weeks of vacation, Nine Holidays including two Floating Holidays of your choosing, Sick/Personal time, Volunteer Time Off (VTO), 403b Retirement plan (similar to a 401k), optional Health and Wellness events, and much more.

Pay range: $71,700.00 - $87,900.00 annually, depending on experience. Exempt position.

#NHC23

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