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Providence Health & Services Provider Network Development Manager in Torrance, California

Description:

Providence is calling a Provider Network Development Manager (Full time/Day shift) for the Providence Medical Institute. This position will be based in Anaheim, CA and support growth across Orange County.

We are seeking a Provider Network Development Manager who will be responsible for the growth and profitable development of the provider network in assigned area(s), and is the direct interface among Providence St. Joseph Health and the High Performing Network (HPN). Promotes population health initiatives aimed at improving the patient experience and health outcomes.

The position will focus on relationship development and recruitment of PCPs, specialist and ancillary providers. Knowledge of full range of network development ranging from selecting providers, negotiations and contracting is preferred.

In this position you will:

  • Growth

  • Work collaboratively with offices, PSJH marketing team and brokers to drive membership growth and retention

  • Monitor and identify trends on membership decline and escalates to leadership as appropriate

  • Address primary care and specialist network specific issues identified as part of dis-enrolled member calls

  • Assist with Medicare Annual Enrollment Period (AEP) efforts by working with offices, marketing team, and brokers; attend AEP events with marketing to strengthen relationships with PCPs

  • Service

  • Serve as single-point-of-contact to the physician network and is accountable and responsive to physician needs

  • Respond timely and appropriately to provider issues, work with other groups/central departments to resolve issues and update providers and office staff regularly through to resolution

  • Is proactive in identifying issues and determining root cause so that they can be resolved timely and completely. Escalate certain issues as appropriate to leadership

  • Build collaborative relationships with Network physicians and their office staff

  • Collaborate with hospital ministries to achieve strategic objectives

  • Manage a scheduled cadence for touch points and ensures that agreed upon agenda is followed and action items are documented and tracked

  • Visibility

  • Attend external office staff meetings and community/town hall meetings, as required, and completes any action items that may arise from those meetings

  • Maintain awareness of providers interested in further aligning with PSJH on new business opportunities, and on shifting market/competitive dynamics that would impact the Network

  • Regularly educate offices on their current performance on key performance indicators (KPIs)

  • Quality

  • Monitor performance of assigned PCPs on a scorecard, identify low performing PCPs and work with Network leadership to develop action plan for specific metrics needing improvement. Work with office to deploy action plan and monitors progress. Intervenes and escalate issues as appropriate

  • Engage, seek assistance from Network Medical Director and/or Quality Manager

  • Support and help practices to earn the maximum bonus possible related to Clinical Quality and Patient Satisfaction measures

  • Engage Network physicians and staff in promoting appropriate clinical pathways

  • Expected to travel to physician offices or other facilities as needed

  • Perform other duties as assigned

Qualifications:

Required qualifications for this position include:

  • Bachelor's Degree or equivalent work experience: Minimum 5 years of experience within a health system, medical group/IPA or related healthcare organization. Healthcare industry sales or provider relations experience. Experience in overall business analysis including marketing, quality and financial data. Demonstrated experience developing successful working relationships with physicians Or equivalent educ/experience

  • 3 years general healthcare, administrative support, project management or provider services work experience

  • Must be knowledgeable about incentive programs, contract reimbursement, practice and network profitability, ACOs and other HCP initiatives, as applicable

  • Must be knowledgeable about the various quality measures and improvement programs, and educates the offices on how to improve performance

  • Demonstrated accountability for assigned network of physicians and practices required

  • Demonstrated ability in leading and developing high performing teams required

  • Ability to work effectively with all levels of personnel (e.g., MD, office staff) required

  • Must possess excellent communication and interpersonal skills, with the ability to be personable yet persistent

  • Must be a team player with strong listening skills

  • Must take initiative and be proactive

  • Must be detail-oriented with strong problem solving skills

  • Robust analytical skills with an emphasis on data-supported decision making required

  • Good understanding of HMO systems' provider reimbursement mechanisms required

  • Knowledge of CPT-4 and ICD-10 coding systems required

  • Excellent computer skills including customer relationship management tools (CRM) required

  • Expertise in Microsoft Office applications (Word, Excel, PowerPoint) required

  • Ability to travel based on business needs required

Preferred qualifications for this position include:

  • Master's Degree in Healthcare Administration (MHA), Business Administration (MBA) or related area

  • 5 years work experience in a health plan, managed care organization, medical group, physician office or network setting

  • Operations work experience with a track record of driving business and financial performance (profit/loss)

  • Leadership position experience in network development, business development and provider relations preferred

About the hospital you will serve:

Providence Health & Services is further developing its physician integration strategy. Historically, the largest asset has been Providence Medical Institute, a medical foundation that provides administrative and other support services to affiliated medical groups. Providence Medical Institute is expected to grow significantly in the next several years, bringing with it facilities, staff and physician growth to support that objective.

For information on our comprehensive range of benefits, visit:

http://www.providenceiscalling.jobs/rewards-benefits/

Our Mission

As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.

About Us

Providence Health & Services is a not-for-profit Catholic network of hospitals, care centers, health plans, physicians, clinics, home health care and services guided by a Mission of caring the Sisters of Providence began over 160 years ago. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

Schedule: Full-time

Shift: Day

Job Category: Analytics/Business Intelligence

Location: California-Torrance

Req ID: 262651

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