Manager Network Management - Gulf Coast, Mississippi

Health Care Service Corporation•Houston, TX

5d•Hybrid

About The Position

At CareAllies, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Job Summary This position is responsible managing daily activities and implementation of strategies for provider HEDIS and STARS performance, recruitment and contracting of physicians, physician groups and facilities including large or complex groups/facilities (large independent hospital systems, integrated & non-integrated systems, value based contracting, etc). The individual in this role will develop and maintain relationships with providers, ensure strategic coverage for assigned territory, be responsible for education of providers, and for ongoing provider service. As a manager, this individual will lead a team of Network Operations Coordinators. This person will guide and educate the team to deliver the needed support services for our clients. This person is responsible for the management, mentoring and training of a team responsible for provider contracting and provider support resources, providing subject matter expertise to improve efficiencies and results. This person must have ability and willingness to travel within assigned areas of responsibility, including overnight stays. CareAllies’ consultative approach emphasizes physician engagement, delivery system organization and culture change, actionable data and analytics, as well as patient engagement to support treatment plans. We collaborate with providers to drive change and ensure success in a value-based market.

Requirements

Bachelor Degree and 5 years provider contracting experience OR 9 years managed care experience including 5 years provider contracting experience
Extensive knowledge of provider and facility contracting, products, and claims/processing systems
Leadership skills to oversee staff, implement initiatives, and work across the company to resolve issues
Negotiation skills
Relationship building skills
Knowledge of marketplace
Meet deadlines and work well under pressure
Verbal and written communication skills to interact with all levels of corporate personnel and providers
PC proficiency to include Microsoft Office
Analytical skills
Project management skills to lead or participate in projects or initiatives
Ability and willingness to travel within assigned areas of responsibility, including overnight stays

Nice To Haves

Previous HEDIS and/or CMS STARs experience
Solid understanding of health insurance, customer messaging/design and project management
Expert level of Excel preferred (knowledge of pivot tables, VLOOKUP, etc.)
Experience in financial/trend analysis
Team player with proven ability to foster and manage working relationships within a matrix environment to obtain buy-in and drive results

Responsibilities

managing daily activities and implementation of strategies for provider HEDIS and STARS performance
recruitment and contracting of physicians, physician groups and facilities including large or complex groups/facilities (large independent hospital systems, integrated & non-integrated systems, value based contracting, etc)
develop and maintain relationships with providers
ensure strategic coverage for assigned territory
responsible for education of providers, and for ongoing provider service
lead a team of Network Operations Coordinators
guide and educate the team to deliver the needed support services for our clients
management, mentoring and training of a team responsible for provider contracting and provider support resources, providing subject matter expertise to improve efficiencies and results