Healthcare Network Manager

True Vine Concepts LLC; Los Angeles (CA); On-site; USD 52,000 - 62,400; Full time

Benefits offered by this job

Holidays, Vacation and Sick Days

Medical, Dental and Vision insurance (

401K after 6 months

Job summary

True Vine Concepts LLC seeks a provider relations coordinator to establish and maintain relations with healthcare providers across a defined region in California. You will educate staff, resolve complex issues, and support managed care policies through onsite visits and calls.

You’ll recruit network providers, develop educational materials, and conduct site visits to ensure policy adherence and program success. A Bachelor’s degree is preferred and strong communication is essential.

Qualifications

• Excellent oral and written communication and presentation skills.
• Excellent organizational, prioritizing, and multi-tasking skills required.
• Ability to use good judgment in decisions within scope and handle sensitive issues with tact and diplomacy.
• Proficient in Microsoft Office (Word, PowerPoint, Excel).
• Ability to use a variety of databases for research and entry of information.

Responsibilities

• Investigates and responds to provider concerns; liaises between providers and IPA departments in responding to questions and resolving issues.
• Identifies network gaps and performs recruitment to address community network needs.
• Builds and maintains relationships with all network providers.
• Trains provider/ancillary offices via onsite visits and by telephone regarding SPN IPA policies, procedures, and resources.
• Creates educational materials and formal presentations.
• Conducts and maintains office site visits to service providers with training and education, resolves issues, educates and interprets staff/providers on policies and procedures, collects credentialing information and reviews HEDIS information.
• Educates providers on the use of IPA provider information forms. Follows up with providers on incomplete forms to obtain required information.
• Resolves complex authorization or claims issues. Identify potential system issues, collaborate with affected departments to ensure resolution.
• Conducts, quarterly utilization management meeting, annual and ad hoc, and provider/ member surveys. Coordinates, attends, and participates in various meetings both on and off-site as assigned.
• Creates Corrective Action Plans (CAPS) for provider sites that did not meet standards. Monitors compliance with CAP.
• Uses databases and tracking systems to document and retrieve information and run reports.
• May be required to report on major points, resolved and pending action items.
• Required to work with minimal supervision.
• Other duties as assigned.

Skills

Communication skills

Microsoft Office

Database proficiency

Driver's license

Ability to handle interruptions

Education

Bachelor’s degree (preferred)

Tools

Microsoft Word

PowerPoint

Excel

Job description

Overview

To establish and maintain excellent relationships with the healthcare provider network in a specific geographic region, including healthcare practitioners, office staff, and administrators. Works closely to identify and resolve complex issues, provides education and staff training. Provides service and education via onsite visits and telephone. Assists providers with understanding managed care of California's policies and procedures and assists with resolving issues that arise.

Responsibilities

• Investigates and responds to provider concerns. Serves as a liaison between providers and SPN,IPA departments in responding to questions and resolving issues. Assists with research and disposition of provider appeals and grievances.
• Identifies network gaps and performs recruitment to address community network needs.
• Build and maintains relationships with all network providers.
• Trains provider /ancillary offices via onsite visits and by telephone regarding SPN IPA policies, procedures, and available resources, referral, claim processing, portal access.
• Creates educational materials and formal presentations.
• Conducts and maintains office site visits to service providers with training and education, resolves issues, educates and interprets staff/providers on policies and procedures, collects credentialing information and reviews Healthcare Effectiveness Data and Information Set (HEDIS) information.
• Educates providers on the use of IPA provider information forms. Follows up with providers on incomplete forms to obtain required information.
• Resolves complex authorization or claims issues. Identify potential system issues, collaborate with affected departments to ensure resolution.
• Conducts, quarterly utilization management meeting, annual and ad hoc, and provider/ member surveys. Coordinates, attends, and participates in various meetings both on and off-site as assigned.
• Creates Corrective Action Plans (CAPS) for provider sites that did not meet standards. Monitors compliance with CAP.
• Uses databases and tracking systems to document and retrieve information and run reports.
• May be required to report on major points, resolved and pending action items.
• Required to work with minimal supervision.
• Other duties as assigned.

Qualifications

Education and Experience

• Bachelor’s degree in health care administration, business, or public relations preferred, or equivalent combination of education and experience; prior experience with physician offices or managed care, IPA or health insurance environment preferred.

Requirements

• Excellent oral and written communication and presentation skills.
• Excellent organizational, prioritizing, and multi-tasking skills required.
• Ability to use good judgment in making decisions within scope of authority and handle sensitive issues with tact and diplomacy.
• Proficient in Microsoft Office (Word, PowerPoint, Excel).
• Ability to use a variety of databases for research and entry of information.
• Valid California driver’s license and proof of current automobile.
• Must be able to work in a fast-paced environment and maintain courtesy and composure.
• Ability to function effectively with frequent interruptions.

Work Environment And Physical Demands

Hours: Mon – Friday 40 hrs. a week.

At least 50% of work time is spent driving and more than 30% of work time is spent in office. Ability to lift, carry or move objects of varying size, weighing up to 15 lbs.

Compensation and Benefits

Paid: Holidays, Vacation and Sick Days.

Compensation between $25 and $30/hr X 40 hours a week. Medical, Dental and Vision insurance available after 90 days. 401K after 6 months.