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Hours Full-time, Part-time
Location Merced, CA
Merced, California

About this job

Tracking Code
569-798
Job Description
The internal title is Provider Services Network Manager.
There is one (1) position available and it can be filled in either Scotts Valley, Salinas or Merced.
SUMMARY DESCRIPTION: Under direction, this position:
  • Manages, plans, organizes and implements provider network development and maintenance;
  • Manages, supervises, mentors and trains assigned staff;
  • Monitors provider network to ensure access to and availability of providers;
  • Identifies and implements unit- and department-level goals, objectives and performance metrics in coordination with the Provider Services Director and other department leadership; and
  • Performs other duties as assigned.
DUTIES AND RESPONSIBILITIES:
  • Manages, plans, organizes and implements provider network development and maintenance, with duties including but not limited to:
  • Developing, implementing and maintaining provider recruitment and servicing standards, goals and objectives;
  • Developing and maintaining relationships with providers;
  • Overseeing provider contractual compliance and providing related education;
  • Developing and implementing provider recruitment strategies based upon market analysis, monitoring of provider satisfaction with payment policies, provider capacity and accessibility;
  • Retaining the provider network by ensuring effective provider orientation, training, and timely contract/amendment follow-up;
  • Overseeing delivery of incentive payments, ensuring compliance with contractual timeframes, and escalating issues as appropriate;
  • Ensuring preparation, maintenance and distribution of effective provider updates, communications and contributing to provider manual and directory production;
  • Overseeing development and implementation of annual provider education curriculum and provider recruitment materials;
  • Coordinating Alliance provider workshops and involving other Alliance staff, as appropriate;
  • Ensuring compliance with new provider training requirements and conducting new provider training;
  • Participating in high-level workgroups and projects;
  • Designing programs, policies, and workflows to meet provider needs;
  • Overseeing departmental response to provider dispute and problem resolution;
  • Overseeing field office locations, including participating in strategic planning and project implementation with Regional Operations Directors; and
  • Developing staff resource materials for new program implementations and benefits.
  • Manages, supervises, mentors and trains assigned staff, with duties including but not limited to:
  • Managing and supervising staff, setting goals and objectives, delegating and assigning work;
  • Providing mentoring, coaching, and development and growth opportunities to staff;
  • In conjunction with the Provider Services Director, interviewing and participating in the selection of staff;
  • Evaluating employee performance, providing feedback to staff, and coaching and counseling or disciplining staff when performance issues arise;
  • Assisting subordinate supervisors with orienting new staff to the Provider Services function and with on-going supervisory responsibilities;
  • Overseeing or conducting staff training, including the development and maintenance of training materials, in conjunction with the Training and Development team; and
  • Overseeing network staff in field office locations.
  • Monitors provider network to ensure access to and availability of providers, with duties including but not limited to:
  • Ensuring that network operations are functioning in accordance with contractual and regulatory accessibility standards;
  • Participating in regular market share analysis and ensuring that an accurate and timely recruitment list is maintained;
  • Monitoring and evaluating network capacity and the network's ability to meet timely access standards;
  • Overseeing the annual Timely Access Survey and required follow-up with providers found to be deficient; and
  • Developing strategies to address any non-compliance with accessibility standards and monitoring for remediation.
  • Identifies and implements unit- and department-level goals, objectives and performance metrics in coordination with the Provider Services Director and other department leadership, with duties including but not limited to:
  • Participating in discussions to identify issues and potential solutions;
  • Conducting research and making recommendations;
  • Preparing reports and making presentations;
  • Informing staff of goals, objectives and performance metrics and supporting staff in meeting expectations; and
  • Representing the department internally and externally at meetings and on committees, as assigned.
  • Performs other duties as assigned.
EDUCATION AND EXPERIENCE:
  • Bachelor's degree in Health Administration or a related field and three (3) years of management level experience in managed care, which included experience with complaint/grievance resolution systems and activities and at least two (2) years of supervisory experience, or any combination of education and experience which would provide the required knowledge and abilities;
JOB SPECIFIC KNOWLEDGE, SKILLS AND ABILITIES:
  • Working knowledge of the California Medi-Cal program and entitlement programs;
  • Working knowledge of and ability to utilize standard negotiating and marketing techniques;
  • Working knowledge of and proficiency with Windows based PC systems and Microsoft Word, Outlook, PowerPoint and Excel;
  • Some knowledge of the tools and techniques related to program and project management;
  • Ability to manage, supervise, mentor, train, and evaluate the work of staff;
  • Ability to organize and prioritize the work of others, delegate effectively, and follow up on work assignments;
  • Ability to utilize good judgment and tact when interacting with health care providers, members and other stakeholders;
  • Ability to act as a technical resource and explain regulations, processes, and programs related to area of assignment;
  • Ability to provide leadership and facilitate meetings;
  • Ability to foster effective working relationships, influence others, and build consensus with individuals at all levels in the organization;
  • Ability to identify issues, conduct research, gather and analyze information, reach logical and sound conclusions, and make recommendations for action;
  • Ability to effectively, clearly and independently document, summarize and resolve complex issues.
  • Ability to work independently, manage assigned workload, make decisions related to areas of functional responsibility, and recognize issues requiring escalation;
  • Ability to manage the development and implementation of projects, systems, programs, policies and procedures;
  • Ability to analyze and interpret legal, regulatory and contractual language;
  • Ability to analyze data and prepare written and oral reports and make effective presentations;
  • Ability to develop training materials, in conjunction with Training and Development staff, and conduct training; and
  • Ability to create forms, correspondence, and other program documents.
ALLIANCE STANDARD KNOWLEDGE, SKILLS AND ABILITIES:
  • Ability to communicate effectively, both orally and in writing;
  • Ability to establish and maintain effective and cooperative working relationships with Alliance staff and others contacted in the course of the work;
  • Ability to assume responsibility and exercise good judgment in making decisions within the scope of authority of the position;
  • Ability to think and work effectively under pressure and accurately complete tasks within established times;
  • Ability to prioritize tasks and deadlines;
  • Ability to maintain confidentiality; and
  • Valid California Driver License, transportation and automobile liability insurance in limits acceptable to the Alliance.
DESIRABLE QUALIFICATIONS:
  • Some knowledge of provider networks in Santa Cruz, Monterey and Merced counties.
WORK ENVIRONMENT AND PHYSICAL DEMANDS:
  • Ability to sit in front of and operate a video display terminal for extended periods of time;
  • Ability to bend, lift and carry objects of varying size weighing up to 10 pounds; and
  • Ability to travel to different locations in the course of work.
ALL ALLIANCE EMPLOYEES ARE EXPECTED TO:
  • Comply with all Alliance safety requirements; and
  • Adhere to all Alliance policies and procedures.
The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The Alliance reserves the right to revise this job description at any time.
The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status.
Applicants must be currently authorized to work in the United States on a full-time basis.
Job Location
Merced, California..... click apply for full job details