Manager of Provider Network Teams at Partnership HealthPlan of California

Redding, California, United States -

Full Time

Start Date

Immediate

Expiry Date

17 Jun, 26

Salary

133977.94

Posted On

19 Mar, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Leadership, Provider Performance Oversight, Network Education, Training, Policy Implementation, Regulatory Compliance, Performance Monitoring, Customer Service, Public Speaking, Corrective Action Plans, Webinar Technology, Liaison, Conflict Resolution, Staff Development, Performance Feedback, Written Communication

Industry

Insurance

Description

Overview Manage day to day operations; provide leadership, support, and direction to the ProviderPerformance Oversight and Network Education and Training staff. Ensure the highest level ofprovider education, training, and oversight to ensure the network stays informed regardingpolicies and procedures, DHCS All Plan Letters and other State and Federal regulations. Monitorprovider performance and identify opportunities for improvement. Monitor established goals andmeet deadlines. Retain provider network through excellent customer service and education. Responsibilities ▪ Manage daily operations of Network Education and Training and Provider PerformanceOversight teams▪ Provide direction, support, and supervision to staff▪ Responsible for all provider education and training programs and oversight activities▪ Develop provider education materials▪ Create provider bulletins and newsletter articles▪ Establish and monitor corrective action plans▪ Enhance use of webinars, video conferencing, new technology for provider education▪ Conduct public meetings as facilitator or educator, requires excellent public speaking skills▪ Oversight and participate in provider education/training sessions▪ Establish goals, monitor activities and ensure timelines/goals are met▪ Conduct targeted provider education based on reports and monitor effectiveness of trainings▪ Liaison to Claims department/claims resolution staff for provider issues▪ Liaison to Health Services department▪ Assist with resolution of provider complaints/appeals/issues▪ Establish strong working relationships with key provider billing and authorization staff▪ Develop agenda topics and oversee Provider Education and Networking meetings▪ Accompany Representatives from PR, Claims, and Health Services on Hospital/LargeGroup Operations/Service meetings.▪ Review Partnership educational materials and content. Meet with internal Partnership staffprior to provider meeting to ensure accuracy. Facilitate, lead the meetings.▪ Provide performance feedback and counseling to staff▪ Provide staff development and education.▪ Conduct annual performance reviews.▪ Act as back up to other Provider Relations department Managers, Associate Director andDirector when needed. Qualifications Education and Experience Bachelor’s Degree in Healthcare, Marketing, Public Relations, orrelated fields, minimum three (3) years in healthcare, marketing, orpublic relations in a managed care environment; or equivalentcombination of education and experience. Special Skills, Licenses and Certifications Ability to disseminate Medi-Cal policies and managed care concepts.Knowledge of business software applications. Knowledge of managedcare concepts, policies, and procedures. Valid California driver’s licenseand proof of current automobile insurance compliant with Partnershippolicy are required to operate a vehicle and travel for company business. Performance Based Competencies Excellent oral and written communications skills. Excellentorganization skills with the ability to prioritize assignments, maintainaccurate records, and meet deadlines. Ability to use good judgment inmaking decisions and handle sensitive issues with tact and diplomacy. Work Environment And Physical Demands Ability to use a computer and video conferencing equipment and createPowerPoint presentations. When required, ability to lift, carry, or moveobjects of varying sizes, weighing up to 30 pounds. All HealthPlan employees are expected to: Provide the highest possible level of service to clients; Promote teamwork and cooperative effort among employees; Maintain safe practices; and Abide by the HealthPlan’s policies and procedures as they may from time to time be updated. HIRING RANGE: $103,059.95 - $133,977.94 IMPORTANT DISCLAIMER NOTICE The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

Responsibilities

This role involves managing the daily operations and providing leadership, support, and direction to the Provider Performance Oversight and Network Education and Training staff. Key duties include ensuring provider education and oversight regarding policies, monitoring performance, and retaining the provider network through excellent service.