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Network Management Specialist
1 month ago
JOB DESCRIPTION:
- Assesses network needs, analyzes network composition, and using organization databases, application of regulatory requirements, accreditation entities, and other resources, recruits individual, group, and/or organizational providers to meet network adequacy standards and assure quality network
- Conducts and coordinates contracting and amendment initiatives
- Provides issue resolution and complex troubleshooting for providers
- Conducts provider education and provider relation activities, providing necessary written materials
- Conducts administrative provider site visits and coordinates report development and completion according to contractual requirements or ad hoc requests
- Coordinates Public Policy Research Center (PPRC) activities to assure maintenance of current credentialing status, and evaluation and appropriate actions of quality of care issues and complaints against providers
- Conducts and manages ongoing audits of provider compliance with policies and procedures as well as contractual obligations for multiple customers
- Develops work plans to address audit requirements
- Works with management to draft, clarify, and recommend changes to policies that impact network management
RESPONSIBILITIES:
- Knowledge of National Committee for Quality Assurance (NCQA) requirements
- Ability to work independently and prioritize activities
- Intermediate knowledge of Microsoft Office Suite, specifically Excel
- Strong presentation skills using PowerPoint
- Previous experience in network development, provider recruitment, or provider contracting
Top 3 Must-Haves (Hard Skills):
- Customer service experience
- Intermediate knowledge of Microsoft Office Suite, specifically Excel
- Strong presentation skills using PowerPoint
- Provider recruitment and contracting experience
Nice-To-Haves (Hard Skills):
- Sales experience
- Knowledge of National Committee for Quality Assurance (NCQA) requirements.
- Military experience / Background
- Bilingual in Spanish and English
WORK EXPERIENCE:
- Network 1+ years
- Minimum of 1 year experience in a related position/field.
- Previous experience in network development, provider recruitment, or provider contracting.
EDUCATION:
- Bachelor (Preferred) (work experience can be considered over the Degree)
Must be a United States Citizen
3-6 months contract position could change (100 Percent Remote)
Monday-Friday 8:00 AM - 5:00 PM - Must have some flexibility to work in different time zones
Proper email communication will only be done to and from @astyra.com email addresses. Please ensure you are communicating with approved Astyra recruiters by checking this point when receiving offers and messages from us. Please ensure you are communicating within these guidelines and proper channels for the quickest possible interview consideration
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