Provider Network Manager
New Century Health is leading transformative change in specialty care management. By combining medical management expertise with a deep understanding of healthcare informatics, physician management and healthcare technology systems development, we generate insights that drive leading edge and effective innovation. What does this mean to you? It means that when you join us, you will be a key contributor to one the fastest growing healthcare services in the National Oncology and Cardiology care management space today. With your knowledge, skills and abilities, you will impact the delivery of care and directly contribute to our ability to positively impact and meet the critical unmet needs of patients suffering from all types of cancer.
We support our employees with an outstanding benefit package that features programs like employee paid medical benefits, 100% match on your 401k contribution up to 4% of your base salary, generous tuition reimbursement, as well as above average paid time off. If you are interested in working with some of the most dedicated, passionate and smartest people on the planet, express your interest in speaking with us and we will respond immediately.
The Provider Network Manager is responsible for building and maintaining a professional and positive working relationship with, but not limited to, CEOs, CFOs, Medical Directors, Director of Nursing, Clinical Leadership, Participating Providers, Prior Authorization Staff, Client Representatives, etc. Contracting maybe involved. Serves as the liaison between provider and New Century Health’s internal departments to address and resolve issues, as needed. Conducts provider in-servicing which provides a clear interpretation of organization’s policies and procedures related to various administrative/operations functions. Provides continuous provider education to all network providers.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Responsible for building and maintaining a professional and positive working relationship with, but not limited to, CEOs, CFOs, Medical Directors, Director of Nursing, Clinical Leadership, Participating Providers, Prior Authorization, Client Representatives, etc.
- Responsible for conducting provider in-services and educating network providers, and supporting office staff on process/delivery system and company policies and procedures within the established time frames and thereafter as necessary, either on-site or via webinars.
- Responsible for conducting in-depth monthly/quarterly program reviews with CEOs, CFOs, Medical Directors, Director of Nursing, Clinical Leadership, Participating Providers, Prior Authorization Staff, Client Representatives, etc.
- Responsible for incoming provider calls, documenting (in CRM) and resolving issues presented. Will seek the assistance of the Sr. Director, National Provider Operations or call upon other departments as needed.
- Responsible for identifying provider targets and initiating/finalizing provider contract negotiations. Will seek assistance of Sr. Director, National Provider Operations when needed.
- Assists in developing and maintaining provider in-service materials.
- Responsible for utilizing only company approved educational materials that conform and are in compliance with all state, CMS or any other applicable regulatory agency.
- Responsible for communicating any updates to network providers in a timely matter.
- Assists upper management in analyzing network’s cost effectiveness, marketability, stability, and accessibility.
- Interacts and participates with other departments to accomplish company- wide goals and objectives.
- Under the direction of the appropriate department may assist in addressing provider related issues including but not limited to claims; utilization; member grievances and appeals; member complaints, provider grievances and appeals, etc. in a timely and professional manner.
- Completes departmental projects as requested.
- Assists health plan in member transitioning.
- Under direct clinical oversight and supervision, may assist in gathering certain information and follow-up on pending requests while following defined algorithms.
- Researches and identifies cause for specialty leakage, address, resolve and educate responsible parties.
- Acts with honor and integrity, serving as a role model for the company.
- Respects and maintains HIPAA confidentiality guidelines.
- Acts as an interdepartmental liaison between all New Century Health offices, departments, and committees.
- Performs other duties as assigned.
EDUCATION and/or EXPERIENCE:
- Bachelor’s degree or three (3) plus years’ experience in healthcare with strong emphasis in Provider Relations and/or Network Development.
- Must have strong knowledge of managed care terminology
- Broad knowledge of delivery systems and related industry terms.
OTHER SKILLS and ABILITIES:
- Excellent verbal, writing and presentation skills.
- Excellent interpersonal skills.
- Extremely organized and detail oriented with exceptional follow through skills.
- Ability to multi-task in a fast pace environment
- Can adapt quickly to change
- Have strong negotiations skills.
- Ability to conduct physician in-servicing (training sessions)
- Excellent relationship building skills.
- Must have knowledge of Microsoft programs (i.e. Word, Excel).
- Able to travel as needed up to 50%.
- Position will cover several states including WI, MI, IA, CO, MN and ND.
- Bilingual English/Spanish preferred.