Provider Network Management Analyst

Community Behavioral Health.•Philadelphia, PA

About The Position

Provider Network Management Analyst is primarily responsible for supporting the Provider Network Access and Development and the Provider Contracting teams with data analysis to inform provider network adequacy, capacity and disparities and to address need areas to support timely and effective access to behavioral health services and meet network adequacy standards.

Requirements

Education: Bachelor’s Degree in Healthcare Management, Public Health, or Analytical Field required. Master’s Degree preferred.
Relevant Work Experience: At least 3 years of direct experience working in a managed care environment with information systems, data analytics, and/or provider operations.
Knowledge of the Pennsylvania Medicaid program
Strong data analytics experience
Advanced critical thinking and analytical skills to interpret sometimes ambiguous requirements
Encourage and promote active team process engagement and individual ownership
Exceptional communication (verbal and written) skills
Strong attention to detail to ensure quality and accuracy in deliverables
Comfortable with ambiguity and able to set your own direction
Must work well under pressure and be able to meet aggressive deadline
Ability to manage and coordinate multiple projects and deadlines while meeting quality standards
Intermediate proficiency in Microsoft Outlook, Word, Excel and PowerPoint
Experience with Network Analysis software and reporting such as GeoAccess
Experienced user of Microsoft Access and SQL programming
Must have the ability to quickly learn and use new software tools

Responsibilities

Maintain thorough and complete knowledge of the CBH provider network, including as new initiatives are implemented.
Conduct and create ongoing process for data analysis, reviewing the accuracy and integrity of data; monitoring the provider network against member demographics, utilization and other targeted population indicators.
Create and conduct ongoing processes to monitor member utilization of in-network and out of network (OON) providers, and identify OON providers not being utilized by members
Lead provider network analyses and create reports to evaluate service utilization, adequacy and accessibility
Conduct ongoing research in relation to provider network management and offer recommendations to ensure alignment with the PA Department of Human Services’ Healthchoices Behavioral Health Program Standards and Requirements.
Assist with updating annual Provider Network and Member Needs Assessments.
Run reports as requested by regulatory bodies
Liaise with Information Technology (IT) department and other relevant departments to complete data-oriented tasks.
Gather and interpret data as well as offer recommendations for program/service proposals and need areas identified through Network Adequacy
Review and prepare analysis for procurements, including relevant demographics, treatment utilization and related gaps for target populations
Review and prepare analysis of the provider network, including maximum licensed capacity, current network capacity, and member need and access to services offered by CBH’s provider network
Create protocol (in conjunction with the unit Manager) regarding how data will be obtained, evaluated and incorporated into Provider Network Management projects
Work with Provider Network Management team members to ensure efficient workflow of procurement process
Perform other related duties and projects as assigned.
Ability to travel and work nontraditional work hours when necessary