Job description

Brief job information:
The Provider Network Manager manages the development of the provider networks to meet the strategic goals for all of CCHP’s product lines. The position maintains the integrity of the managed care or potentially other downstream payer contracts to satisfy CCHP’s strategic quality and regulatory objectives. The position will evaluate and maintain direct or downstream relationships with providers to be in regulatory compliance, within reimbursement structure standards and conforming to other key process controls. Additional routine activities include provider data management and managing the day-to-day activities of the Network Management department and staff.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Ensures the provider network meets the health care needs of CCHP members.
• Oversees training, orientation and coaching for performance improvement within physician practices.
• Acts as a liaison with the provider community to maintain and/or improve relationships between providers and health plan.
• Ensures timely health plan updates to network providers.
• Manages provider performance and supports the development and implementation of value-based contract relationships in support of business strategies.
• Ensures timely resolution of escalated provider issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.
• Conducts audits of network adequacy for each service area in order to maintain member access at desired levels.
• Works collaboratively with and makes recommendations to Contracting to enhance CCHP’s provider network.
• Monitors provider network contracts to ensure compliance with financial and operational terms.
• Develops and updates policies and procedures related to provider network to comply with external regulators and internal business requirements.
• Performs on-going analysis of data and information looking for opportunities for continuous improvement in health plan operations and in provider relations.
• Accepts and performs other duties as assigned.

QUALIFICATIONS

• Bachelor degree or equivalent in Business Administration, Health Care or related field.
• Master degree or equivalent in Business Administration, Health Care or related field preferred
• Three years’ prior experience in market analysis, product development, business development or provider contracting in a health plan setting preferred.
• Must be able to explain health care financing and its relation to third party provider contractual arrangements.
• Strong interpersonal and communication skills and ability to work effectively with a wide range of constituencies; ability to develop and deliver presentations.
• Excellent time management, organizing and coordinating skills.
• Strong history of achieving personal and corporate goals and objectives.
• Must demonstrate professionalism, good judgment, and tact when dealing with sensitive and confidential issues.
• Strong skills in Microsoft applications including MS Office; graphic software experience preferred.

PHYSICAL REQUIREMENTS

• Able to lift up to 30 pounds
• Use proper body mechanics when handling equipment
• Standing, walking and moving 50% of the day.

In our efforts to control the spread of COVID-19 and its variants, CCHP requires that its employees be fully vaccinated as of their start date. If you require a medical or religious accommodation we will engage in the interactive process with you. Proof of vaccination will be required prior to start. If we make you an offer and you are not yet vaccinated, we will accommodate a delay in start date. CCHP may also mandate that its employees receive vaccine boosters, and all accommodation laws will be followed.

Job Type: Full-time

Pay: $82,000.00 - $124,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• Monday to Friday

Work Location: In person

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