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   Current UPMC employees must apply in HR Direct

Ancillary Network Manager - Western PA

Description

UPMC Health Plan is looking for a dynamic and motivated individual to create and maintain relationships with dental and vision providers in the Western Pennsylvania region.  This role will require 50 - 75% travel to provider offices in the Western PA area and will work from home when not in the field.

The Network Manager will lead a team of professionals that will work in collaboration with network ancillary providers to ensure delivery of high-quality, cost-efficient healthcare services to mutual customers of UPMC Health Plan. This role will be responsible for establishing goals for the department that lead to not only the department's success, but also the overall success of UPMC Health Plan. The Network Manager will interact with other internal and external customers to set appropriate goals and establish priorities for the Network Management staff.


Responsibilities:

  • Assist with network expansion activities as needed.
  • Present provider profiling reports to network providers.
  • Coordinate problem resolution for providers as necessary and ensure ongoing collaboration with providers to support Health Plan initiatives.
  • Identify opportunities to improve clinical and financial performance.
  • Assess the operational patterns of the practice and recommend actions to assist the provider in performance improvement.
  • Ensure ongoing provider communications and training for office staff.
  • Determine the causes of financial and clinical trends, anomalies and communicate these findings to physicians.

 

Qualifications

  • Bachelor's Degree in business, health care, management, or a related field is preferred or equivalent experience is required, 3 years of experience in health care industry or professional business industry.
  • Prior health insurance or experience with healthcare providers preferred.
  • 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 the Health Plan, as well as individual provider offices.
  • Ability to analyze financial and clinical results and to comprehend forecasting models.
  • Willingness to travel extensively to regional service area within Pennsylvania
  • Demonstrated ability to work independently and manage assigned territory


Licensure, Certifications, and Clearances:

  • Valid Pennsylvania Driver's License required

UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct