Network Management Manager - Provider Performance - Pennsylvania
About The Position
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.
- Develop and maintain relationships with providers.
- Ensure strategic coverage for assigned territory.
- Responsible for education of providers and ongoing provider service.
- Lead a team of Network Operations Coordinators.
- Guide and educate the team to deliver needed support services for clients.
- Responsible for the management, mentoring and training of a team responsible for provider contracting and provider support resources.
- Provide subject matter expertise to improve efficiencies and results.
- Ability and willingness to travel within assigned areas of responsibility, including overnight stays.
Benefits
- Health and wellness benefits
- 401(k) savings plan
- Pension plan
- A minimum of 15 days’ of paid time off
- Paid parental leave
- Disability insurance
- Supplemental life insurance
- Employee assistance program
- Paid holidays
- Tuition reimbursement
- Other incentives
- Annual incentive bonus plan
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What This Job Offers
Job Type
Full-time
Career Level
Manager
