Manager, Network Development
Company Name:
WorkStaff USA Staffing Agency
Build and maintain provider networks that promote quality customer outcomes. Develop and implement activities for the recruitment, contracting and retention of effective providers to promote evidence based practices. Partner with providers to track outcomes for members receiving treatment.
Meet with contracted providers to develop long-term relationships, resolve operational issues and collaborate regarding effective treatment modalities and outcomes.
Evaluate and negotiate contracts in compliance with company contract templates and reimbursement structure standards.
Maintain state governmental and community relationships.
Evaluate the need for additional providers and/or specialty treatment services for identified populations.
Analyze provider performance and profiling for interventions data.
Develop market specific provider network business plans, strategies, and goals.
Develop and deliver provider orientation, training, and education materials.
Interface with all levels of the organization in order to ensure provider data accuracy.
Collaborate to evaluate trends, identify preferred practice patterns and provide further education to providers on clinical initiatives and expectations.
Collaborate with Centene health plans to integrate models to enrich members experience.
Qualifications:
Education/
Experience: Bachelors degree in Behavioral Health or equivalent experience. Masters degree preferred. 5
years network development, provider relations, or training experience. Claims and reimbursement system experience and provider business operations knowledge. In-depth knowledge of state compliance and regulatory processes/laws. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff. Working knowledge of managed care industry, behavioral health, evidence-based practices, clinical modalities, behavioral health diagnoses, and levels of care preferred.
License/Certification: Valid drivers license.
Employee Status:
Regular
Job Level:
Manager
Job Type:
Regular
More Information About the Job
How would we describe our team and culture?
There are on this regional team a total of 7 staff across 5 states. The larger network team has approximately 50 staff overall.
What are the top 3-4 things the person in this position will be challenged with in the first 60-90 days?
Build and maintain provider networks that promote quality customer outcomes. Develop and implement activities for the recruitment, contracting and retention of effective providers to promote evidence based practices. Partner with providers to track outcomes for members receiving treatment.
What are we looking for on the resume, and why?
Role is more than provider relations Must understand the market and regulatory processes/laws for Washington state. Analysis and trending for problems Bachelors degree in Behavioral Health or equivalent experience. Masters degree preferred. 5
years network development, provider relations, or training experience. Claims and reimbursement system experience and provider business operations knowledge. In-depth knowledge of state compliance and regulatory processes/laws. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff. Working knowledge of managed care industry, behavioral health, evidence-based practices, clinical modalities, behavioral health diagnoses, and levels of care preferred. License/Certification: Valid drivers license.
Is this a replacement or a new position?
Replacement: Internal employee transferred to another health plan
Where does the position sit in the organization and who does this position report to?
Reports to: Director Network Operations, Provider Relations-Affairs
Does this position have direct reports?
1-2 direct reports
Whats the bonus percentage?
10%
Are we ready to hire the right candidate immediately?
Yes
Is relocation available?
Yes
Is there flexibility in hours and/or the ability to work remotely?
Must be on siteEstimated Salary: $20 to $28 per hour based on qualifications.
WorkStaff USA Staffing Agency
Build and maintain provider networks that promote quality customer outcomes. Develop and implement activities for the recruitment, contracting and retention of effective providers to promote evidence based practices. Partner with providers to track outcomes for members receiving treatment.
Meet with contracted providers to develop long-term relationships, resolve operational issues and collaborate regarding effective treatment modalities and outcomes.
Evaluate and negotiate contracts in compliance with company contract templates and reimbursement structure standards.
Maintain state governmental and community relationships.
Evaluate the need for additional providers and/or specialty treatment services for identified populations.
Analyze provider performance and profiling for interventions data.
Develop market specific provider network business plans, strategies, and goals.
Develop and deliver provider orientation, training, and education materials.
Interface with all levels of the organization in order to ensure provider data accuracy.
Collaborate to evaluate trends, identify preferred practice patterns and provide further education to providers on clinical initiatives and expectations.
Collaborate with Centene health plans to integrate models to enrich members experience.
Qualifications:
Education/
Experience: Bachelors degree in Behavioral Health or equivalent experience. Masters degree preferred. 5
years network development, provider relations, or training experience. Claims and reimbursement system experience and provider business operations knowledge. In-depth knowledge of state compliance and regulatory processes/laws. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff. Working knowledge of managed care industry, behavioral health, evidence-based practices, clinical modalities, behavioral health diagnoses, and levels of care preferred.
License/Certification: Valid drivers license.
Employee Status:
Regular
Job Level:
Manager
Job Type:
Regular
More Information About the Job
How would we describe our team and culture?
There are on this regional team a total of 7 staff across 5 states. The larger network team has approximately 50 staff overall.
What are the top 3-4 things the person in this position will be challenged with in the first 60-90 days?
Build and maintain provider networks that promote quality customer outcomes. Develop and implement activities for the recruitment, contracting and retention of effective providers to promote evidence based practices. Partner with providers to track outcomes for members receiving treatment.
What are we looking for on the resume, and why?
Role is more than provider relations Must understand the market and regulatory processes/laws for Washington state. Analysis and trending for problems Bachelors degree in Behavioral Health or equivalent experience. Masters degree preferred. 5
years network development, provider relations, or training experience. Claims and reimbursement system experience and provider business operations knowledge. In-depth knowledge of state compliance and regulatory processes/laws. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff. Working knowledge of managed care industry, behavioral health, evidence-based practices, clinical modalities, behavioral health diagnoses, and levels of care preferred. License/Certification: Valid drivers license.
Is this a replacement or a new position?
Replacement: Internal employee transferred to another health plan
Where does the position sit in the organization and who does this position report to?
Reports to: Director Network Operations, Provider Relations-Affairs
Does this position have direct reports?
1-2 direct reports
Whats the bonus percentage?
10%
Are we ready to hire the right candidate immediately?
Yes
Is relocation available?
Yes
Is there flexibility in hours and/or the ability to work remotely?
Must be on siteEstimated Salary: $20 to $28 per hour based on qualifications.
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