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   Current UPMC employees must apply in HR Direct

Network Manager - HPL

Description

UPMC Health Plan has an exciting opportunity for a Network Manager in its National Network Management department, located at the U.S. Steel Tower in downtown Pittsburgh.  Post-COVID this role will work in-office 3 days per week with travel to provider offices 2 days per week.  The ideal candidate will have prior experience in health insurance and be comfortable interacting with providers and their staff.

The Network Manager will support the Physician Account Executive (PAE) team and coordinate efforts with other HP clinical departments. They will assist with provider operational initiatives including HCC, CDPS, MA P4P, and CMS Stars. The Network Manager will outreach to providers as related to key departmental goals via phone, email and personal visits. They will assist in obtaining provider information and document their activity in a customer database. The Network Manager will assist in investigating claims issues and effectively communicate their findings.


Responsibilities:

  • Ability to manage relationships with key accounts within the Health Plan physician network is preferred.
  • Collaborate with other Network Leaders and staff to ensure process improvement within department.
  • Coordinate problem resolution for providers as necessary and ensure ongoing collaboration with providers.
  • Present various HP programs and tools to network providers and staff. Follow up with provider as necessary.
  • Effectively manage special projects assigned by Manager, Department Director, Team Leads, and Physician Account Executives. To complete in a timely manner, occasionally, the employee will need to extend hours beyond 40 hour work week.

Qualifications

  • Bachelor's Degree in Business, Health Care, Marketing or a related field is required or equivalent experience.
  • 3 years business/sales or healthcare-related experience required.
  • Health insurance experience highly preferred.
  • Strong written and verbal communication skills are required.
  • Demonstrated leadership, planning, communication, documentation, organization, analytic and problem-solving abilities are required.
  • Ability to attend or accompany Manager/ PAE to various internal and external department and provider/hospital meetings.
  • Effectively interpret and summarize results of various analyses in a timely manner.


Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct