Network Manager
1 day ago
We are seeking a highly skilled Network Manager - Provider Relations to join our team at Regal Medical Group. As a key member of our Provider Relations Network Management team, you will play a crucial role in supporting our network growth and development initiatives in Southern California.
Key Responsibilities:
- Collaborate with the Director of Network Management and Medical Management team to ensure network growth and development initiatives are met and networks are operating within budgets.
- Prepare and negotiate provider contractual agreements during Primary Care, Specialty, and Ancillary recruitment projects.
- Develop and implement strategies to improve network provider engagement and education on company programs and initiatives.
- Oversee network provider deficiencies and work closely with Network Support staff and Medical Management counterparts to ensure network needs/changes are effectively addressed and communicated.
- Ensure timely and accurate completion of PACFs related to incoming documentation received from providers.
- Submit provider profiles to health plans, conduct follow-up to ensure Primary Care Physicians are active in health plan databases, and obtain health plan-assigned provider identification numbers.
- Assist with the resolution of provider grievances and appeals in accordance with contractual requirements and corporate policy.
- Perform on-site visits to physicians, physician groups, hospitals, and ancillary providers to ensure compliance with company policies and procedures.
- Facilitate quarterly Joint Operations Meetings with contracted providers and office staff.
- Ensure accurate and timely data reporting requirements are met, including eligibility and capitation reports, risk sharing, claims timeliness, pharmacy utilization, bed days utilization, encounter data, and audit compliance.
Requirements:
- Minimum of 3 years relevant work experience in Network Management, Contracting, or Provider Relations in a managed care setting, health plan, or large medical group administration.
- Knowledge of contracting principles/tools.
- Excellent verbal and written communication skills.
- Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access, and PowerPoint).
- Ability to travel within the service area 70-80% of the time and have a valid driver's license and insurance.
What We Offer:
- A competitive salary range of $70,304 annually, with potential for additional compensation based on individual performance and market factors.
- A comprehensive benefits package, including employer-paid medical, pharmacy, and dental insurance, vision insurance, flexible spending account, employer-paid life insurance, employee assistance program, behavioral health services, 401(k) retirement savings plan, income protection insurance, and more.
- A fast-paced, exciting, welcoming, and supportive work environment with opportunities for growth and advancement.
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