Dir Reg, TPN

Easterseals Southern California•Ontario, CA

About The Position

Under general direction, serves as primary point of contact for the Network Service Managers, Electronic Health Records Analysts, and administrative assistants, and clinical standards directors as needed. Provides support for associates, service providers, funders, and participants. Ensures Provider Network business transactions are complete and accurate; facilitates grievance resolution; and provides direction on day-to-day operations of the Provider Network. Oversees, develops, and implements quality assurance, clinical staff and provider in-service training programs, including retention efforts. Assists in short and long-term planning for the Provider Network.

Requirements

Requires a MA/MS Degree in Occupational, Physical or Speech Therapy, or Board Certification for Behavioral Analysts.
Must possess and maintain California State License in Occupational, Physical or Speech Therapy or Board certification for BCBA
3-5 years’ of directly related experience; at least 3 of which must be in a supervisory role.
Or a combination of education and experience which demonstrates the ability to perform the core responsibilities of the position.
Demonstrated proficiency in Microsoft Office (Word, Excel, Outlook, PowerPoint), Windows-based applications, internal databases, and internet usage.
Demonstrated organizational, decision-making, and oral and written communication skills, with the ability to communicate effectively with all levels of associates, physician’s office personnel, and the general public.
General knowledge of clinical and business needs and processes within health care organizations
Ability to work independently, and as a team member while maintaining customer-service orientation and professionalism in all interactions.
Ability to demonstrate good judgment, exercise discretion, and maintain a high level of confidentiality in handling sensitive situations and documentation.
Ability to remain focused and flexible while shifting/changing priorities, heavy workload and tight deadlines, and produce high quality work.
Ability to travel locally; maintain driving record in compliance with Transportation Safety Standards; maintain auto insurance and vehicle registration.
Ability to provide proof of required vaccinations or positive titer showing immunity. A signed declination may be acceptable for certain vaccinations.
Ability to pass a post-offer physical examination and a TB test.
Ability to obtain and maintain a criminal record/fingerprint clearance from the Department of Justice and Federal Bureau of Investigation per Easterseals of Southern California and/or program requirements.

Responsibilities

Serves as the primary point of contact and liaison with network providers, participant caregivers, Kaiser Permanente, and other professionals pertaining to the Provider Network.
Monitors Provider Network providers by conducting and managing audits of the provider’s compliance with contractual obligations, including on time report submission, contract fulfillment, and utilization management.
Serves as primary point-of-contact and liaison with participants assigned to a network provider when they have a concern and/or grievance that is not resolved with the Therapy Service Coordinator/Clinical Standards Director and/or Provider.
Manages service provider assignment process and facilitates adequate capacity across the provider networks.
Receives, responds, redirects, reports and/or documents participant, caregiver, associate, and provider interactions as required.
Oversees Provider Network providers to ensure quality service with referrals, assignments, reports, and communications.
Trains, supports, and evaluates services provided by network providers, as necessary.
Assists the network managers in ensuring responsibilities, accountabilities, authorities are defined and understood.
Manages and evaluates performance, and monitors productivity of network coordinators, as assigned by Sr. RVP of Provider Networks.
Conducts weekly meetings with CSDs and Therapy Service Managers for review and monitoring of report submission timelines, caseload, capacity needs of referrals to Therapy Provider Network, and clinical support.
Monitors and supports performance management of network providers.
Oversees provider and associate evaluations, quality assurance reviews and audits, and reports results to Sr. RVP Provider Networks.
Develops and prepares instruction materials and provides specialized training as assigned by Sr. RVP Provider networks.
Monitors the maintenance required updates to training documents for network providers.
Provides initial and ongoing training.
Monitors and supports performance for Network managers, and their direct reports.
Leads Provider Network meetings.
Leads, collaborates, and/or participates in service and/or organizational activities as well as Performance Improvement Projects.
Performs other duties as assigned.