Provider Network Manager, Managed Care

Community Medical Centers   •  

Fresno, CA

Industry: Hospitals & Medical Centers

  •  

Less than 5 years

Posted 47 days ago

Responsibilities:

As a provider Network Manager you will work closely with the business office to manage contracts (e.g. physician and ancillary contracts) for our clients. You will also have the opportunity to serve as a mentor to our contract coordinators.

Responsibilities Include:

  • Responsible for daily activities related to provider relations, credentialing, post-contract administration and provider education.
  • Assists management in network and contract management activities which occur after contract negotiation and in conjunction with contract implementation and ongoing contract compliance.
  • Facilitates contract management meetings with multi-disciplinary departments to monitor contract compliance and oversee problem resolution.
  • Accountable for the accurate maintenance and management of provider databases and for reporting activities required to ensure contractual and regulatory compliance.
  • Develops and implements procedures for contract administration in compliance with departmental policies to ensure contract and regulatory compliance and to address operational needs.
  • Mentors and works with Contract Coordinators providing expertise knowledge to accomplish goals and duties of the department.

Qualifications:

EXPERIENCE AND EDUCATION:

MINIMUM REQUIRED: Bachelor's degree in Healthcare, Business Administration, or related field and three years' experience in managed care, physician office or health plan environments. Seven years relevant experience may be substituted in lieu of education.