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The Provider Network Account Manager III at L.A. Care Health Plan plays a crucial role in managing provider relationships and contracts within the organization. This position is responsible for overseeing all aspects of the provider contracting process, which includes drafting, reviewing, negotiating, and implementing contracts with various healthcare providers. The Account Manager III will work closely with large provider organizations, such as Participating Physician Groups (PPGs), hospitals, and ancillary services, ensuring that L.A. Care maintains strong partnerships with both contracted and non-contracted providers. In this role, the Account Manager III must possess a deep understanding of L.A. Care's governing regulations, policies, and procedures, as well as the operational standards and performance metrics of the providers. This knowledge is essential for conducting tailored provider orientation sessions, making educational visits, and resolving any issues that may arise. The Account Manager III is also tasked with monitoring network adequacy to ensure that services are accessible throughout Los Angeles County, complying with state and federal requirements across all product lines, including Medicaid, Medicare, and Commercial plans. Additionally, the Account Manager III will be responsible for the onboarding training of new managed care contract providers, ensuring they meet the necessary training and credentialing requirements to care for L.A. Care members. This position acts as a Subject Matter Expert, providing mentorship and support to other staff members while managing the complexities of provider relationships and contract negotiations. The role requires excellent organizational skills, attention to detail, and the ability to communicate effectively with a diverse group of stakeholders, including healthcare providers and internal departments.
