Provider Network Coordinator

3 days ago


Orange, California, United States The Midtown Group Full time
About The Midtown Group

Our company is committed to providing exceptional patient care and improving the health outcomes of our communities. We are a dynamic and growing organization that values innovation, collaboration, and excellence.

Job Description

This is an exciting opportunity for a skilled Contracts Manager to join our team. The successful candidate will be responsible for managing provider network contracts, health networks, professional, ancillary, and facility providers.

The ideal candidate will have a strong background in provider contracting, negotiation, hospital, and delegated health network/medical group provider agreements or other complex provider contracts. Experience with Medi-Cal and Medicare lines of business within a health plan or large healthcare delivery system is also essential.

Key Responsibilities
  1. Negotiate and manage provider network contracts, health networks, professional, ancillary, and facility providers as assigned.
  2. Maintain and report the status of Letters of Agreement (LOA) dispositions, develop action plans to transition non-contracted providers to full contracts when possible, and collaborate with other staff to monitor and expedite the credentialing/contracting process.
  3. Optimize and maintain accuracy and integrity of new and existing provider contracts to ensure compliance with Department of Health Care Services (DHCS) and Centers for Medicare & Medicaid Services (CMS) mandates.
  4. Manage project plans when implementing network-wide contract initiatives and coordinate with legal, medical management, provider relations, finance, and OneCare sales and marketing to implement new and renewing provider contracts.
  5. Monitor performance and utilization trends of assigned networks to assess new opportunities for cost savings, alternate delivery models, and financial risk sharing through contractual arrangements.
Requirements
  • Bachelor's degree plus 4 years of experience in provider contracting, negotiation, hospital, and delegated health network/medical group provider agreements or other complex provider contracts.
  • Experience with Medi-Cal and Medicare lines of business within a health plan or large healthcare delivery system.
  • Strong analytical, problem-solving, and project management skills.
  • Ability to work independently and exercise sound judgment.
  • Excellent communication and interpersonal skills.
Benefits

We offer a competitive salary of $43.66 - $69.86 per hour, a comprehensive benefits package, and opportunities for career growth and development.



  • Orange, California, United States Regal Medical Group Full time

    At Regal Medical Group, we are seeking an exceptional Network Development Manager to join our team. This role offers a competitive salary of $85,000 - $110,000 per year.About the Role:The successful candidate will be responsible for managing our provider network, ensuring seamless growth and development initiatives. Key responsibilities include:Collaboration...


  • Orange, California, United States Rivka Development Full time

    Technical Network Project ManagerWe are seeking an experienced and skilled Technical Network Project Manager to lead our network-related projects effectively. The ideal candidate will possess a blend of technical expertise and project management skills to manage daily operations, ensure service delivery, analyze key performance indicators, and maintain...


  • Orange, California, United States Rivka Development Full time

    Rivka Development is seeking a Technical Network Operations Specialist to join our team. As a key member of our network operations team, you will be responsible for managing daily operations, ensuring service delivery, analyzing key performance indicators, and maintaining strong client relationships.Key ResponsibilitiesYou will work closely with the team...


  • Orange, California, United States Alignment Healthcare Full time

    **Job Title:** Network Management SpecialistAbout Us:Alignment Healthcare is a healthcare company that revolutionizes health care for seniors by leveraging its world-class technology platform, innovative care delivery models, deep physician partnerships, and serving heart culture.Job Description:We are seeking a skilled Network Management Specialist to...


  • Orange, California, United States CHOC - Children's Health Orange County Full time

    OverviewCHOC - Children's Health Orange County is a leading destination for children's health, providing exceptional and innovative care to the pediatric population. We are seeking a highly skilled Network Architect and Manager to join our team.SalaryThe estimated salary range for this position is $131,206 - $216,466 per year, based on factors such as...

  • IT Specialist

    4 weeks ago


    Orange, California, United States AmeriPharma Full time

    About AmeriPharmaAmeriPharma is a rapidly growing healthcare company where you can contribute to our joint success on a daily basis. We value new ideas, creativity, and productivity. Our ideal candidate is passionate about their role and willing to grow and change as the company evolves.We offer a full benefits package including medical, dental, vision, life...


  • Orange, California, United States CIBD Full time

    Job DescriptionCIBD is committed to providing comprehensive care for patients with rare, chronic inherited blood disorders. We are seeking a talented Hemostasis Network Administrator to manage the day-to-day operations of the USHTCN, including leadership and USHTCN member communications and policies/systems. This role requires excellent analytical skills,...


  • Orange, California, United States Sonrava Health Full time

    Job TitleDental Benefits CoordinatorAbout the RoleWe are seeking a highly skilled and compassionate Dental Benefits Coordinator to join our team at Sonrava Health. As a key member of our customer service team, you will be responsible for providing exceptional support to our patients and providers, ensuring seamless communication and navigation of our dental...


  • Orange, California, United States Providence Health & Services Full time

    About the RoleWe are seeking a skilled and compassionate Nurse Care Coordinator to join our team at Providence Health & Services.Job SummaryThe Nurse Care Coordinator will play a critical role in delivering high-quality patient care, working closely with our interdisciplinary teams to ensure seamless transitions and effective communication.What You'll...


  • Orange, California, United States First Impulse Full time

    We are seeking an experienced System and Service Technician to join our team at First Impulse. As a key member of our team, you will be responsible for installing and troubleshooting network cabling in a commercial or hospital environment. This includes installing and configuring building systems such as access control, surveillance, audio/video, phone, and...


  • Orange, California, United States Prospect Medical Holdings Full time

    About UsProspect Medical Holdings is a leading provider of healthcare services in California, Texas, and Rhode Island. Our extensive network of primary care and specialty physician services, acute care hospitals, and skilled nursing facilities aims to deliver state-of-the-art healthcare to our 260,000 members.Job SummaryWe are seeking an Inpatient Care...


  • Orange, California, United States UCI Health Full time

    Join UCI Health as a Healthcare Administrative Coordinator and play a vital role in ensuring the smooth operation of our nursing units.About UCI HealthAs the clinical enterprise of the University of California, Irvine, UCI Health is a leading academic health system based in Orange County. Our comprehensive network includes a 459-bed hospital, four hospitals,...


  • Orange, California, United States Nexus HR Services Full time

    ResponsibilitiesThe ideal candidate will be responsible for:Oversight of clinical care provided to PACE participants by Mid-Level Providers.Completing annual reviews of Mid-Level Providers.Participating in provider meetings and ensuring effective communication among team members.Ensuring accurate and efficient coding practices.Couriering specialist network...


  • Orange, California, United States Alignment Healthcare Full time

    **Job Summary:** Alignment Healthcare is seeking a highly motivated Network Management Specialist to join our team. This role offers an exciting opportunity to build and maintain high-performance provider networks.About the Position:You will work closely with other departments to enhance the contracted provider experience consistent with our mission...


  • Orange, California, United States North American Companies Full time

    About the Role: As a Dealer Network Operations Manager, you will be responsible for leading our service team, providing exceptional customer service, and ensuring the service department operates safely and efficiently. This is an outstanding opportunity for a results-driven individual with a passion for taking care of customers, excellent organization...


  • Orange, California, United States Prospect Medical Holdings Full time

    About Us: Prospect Medical Systems is a leading medical system in California, Texas, and Rhode Island. With approximately 9,000 physicians serving over 260,000 members, we offer extensive care services including primary care, specialty physician services, acute care hospital, skilled nursing facilities, behavioral health, and wellness services.Salary:...


  • Orange, California, United States Registry Network Inc. Full time

    Registry Network Inc. is a leading healthcare staffing provider with over 35 years of experience in delivering exceptional temporary healthcare services. Our mission is to aid in the delivery of these services while encouraging our healthcare professionals to achieve greater career enrichment and advancement.About Registry Network Inc.We are California...


  • Orange, California, United States Thomas Talent Network Full time

    Job Title: Senior Patent Counselor Life Sciences">We are seeking a Senior Patent Counselor Life Sciences to join our team at Thomas Talent Network. As a Senior Patent Counselor Life Sciences, you will be responsible for leading patent prosecution efforts in biotechnology practices, working closely with our experienced attorneys to advance the firm's clients'...

  • Healthcare Specialist

    4 weeks ago


    Orange, California, United States Regal Medical Group Full time

    Job Description:Job Title: Provider Support SpecialistJob Summary:We are seeking a highly skilled and motivated Provider Support Specialist to join our team at Regal Medical Group. The ideal candidate will have a strong background in customer service, member retention, and sales, with a minimum of 3 years of experience in a fast-paced call center...


  • Orange, California, United States Thomas Talent Network Full time

    Job Title: Life Sciences Patent Specialist">We are seeking a highly skilled Life Sciences Patent Specialist to join our team at Thomas Talent Network. As a Life Sciences Patent Specialist, you will be responsible for patent prosecution in biotechnology practices, working closely with our experienced attorneys to advance the firm's clients' interests.">The...