Job Description

Job Title: Network Manager, Community Care - Exton, PA
Job ID: 703317
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: Community Care Behavioral Hlth
Department: Netwrk Mgmt-Satellite CH
Location: 1 East Uwchlan Avenue, Exton PA 19341

Description

Do you have a Bachelor’s degree and at least five years’ of experience in health care insurance or in the health care industry? Do you have strong technical skills? If so, UPMC may have the perfect fit for you!

 

 

UPMC is hiring a full-time Network Manager to support the Network Management department within Community Care Behavioral Health. This is a Monday through Friday daylight role (8:30 a.m. – 5:00 p.m.) located in Exton, PA. Minimal travel will be required.

 

 

The Manager, Network leads a team of professionals to work in collaboration with network providers to ensure delivery of high quality, cost efficient behavioral healthcare services to mutual customers of Community Care. The Network Manager will establish goals for the department that lead to not only the department's success, but also the overall success of Community Care. The Manager will interact with other internal and external customers to set appropriate goals and establish priorities for the Network Management staff. The incumbent will also prepare and organize deliverables required for the assigned network(s).



Responsibilities:
  • Collaborate consistently with Regional Director to prepare for and present network updates at OMHSAS monitoring meetings.
  • Conduct Individual Provider Orientation/Service meetings to review Authorization procedures, billing requirements as well as a review of Member rights/responsibilities.
  • Coordinate problem resolution for providers as necessary and ensure ongoing collaboration with providers to support Community Care initiatives.
  • Develop written communication following provider meetings in which quality of care concerns are discussed.
  • Ensure ongoing provider communication through the facilitation of Provider Advisory Committee Meetings (including responsibility for the following: creating agenda, presenting information, leading discussion) to large groups of providers in the respective contracts.
  • In collaboration with Senior Director Network and Regional Director, recruit, train, supervise and evaluate staff assigned to contract.
  • Investigate Licensing Regulations and/or HealthChoices Regulations when presented with provider specific questions.
  • Oversee all network expansion activities for new and existing providers including the following: Developing financial impact analysis Obtaining verification of specialization Reviewing information at Clinical Operations Meeting Reviewing credentialing information Submitting Supplemental Service Enrollment Applications to the State on behalf of the Provider Assist Providers in Service Description Development
  • Oversee daily activities of staff to ensure compliance with workflows and timeframes
  • Participate and prepare materials for Office of Mental Health and Substance Abuse (OMHSAS) Monitoring Meetings
  • Participate in meetings with the County Administration (and/or HealthChoices oversights) who are the direct contract holders for the Medicaid contract with the state.
  • Prepare all contract related network deliverables, including but not limited to Geo-Access reports and waivers, RAI/PEPS information and any on-going monitoring of network activity.
  • Prepare all network agenda items for clinical-operations meetings and follow through with any required action items.
  • Serve as the point person for all provider related inquiries (with the exception of direct claims related questions). This includes, but is not limited to, issues related to the following: Credentialing network expansion fee schedules regulations Allowable billing activities PROMISe related matters

Qualifications

  • Bachelors Degree in business, health care, management, or a related field is required.
  • Masters Degree preferred.
  • 5 years experience in health care insurance or health care industry required.
  • Ability to forge strong interpersonal relationships within the department, other departments, and with the physician network.
  • Strong leadership, planning, communication, documentation, organizational, analytical, and problem solving abilities.
  • Ability to interpret and summarize results of various analyses in a timely manner.
  • Ability to re-engineer processes to positively impact the performance of the department and Community Care, as well as individual provider offices.
  • Ability to analyze financial and clinical results and to comprehend forecasting models.

Licensure, Certifications, and Clearances:

N/A


UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $24.27 to $41.99

Union Position: No

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

QUALITY & SAFETY
DIGNITY & RESPECT
CARING & LISTENING
RESPONSIBILITY & INTEGRITY
EXCELLENCE & INNOVATION

UPMC provides a total rewards package that can help you achieve the goals you have for your career and your personal life. Whether you want to learn a new skill through a training course, reach personal health and wellness targets, become more involved in your community, or follow a career path that provides you with the right experience to be successful, UPMC can help you get to where you want to be.



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