PROVIDER NETWORK MANAGER

Description

Provider Network Manager oversees the provider network, provider relationships, and quality of service delivery through coordination of long-term supports and services. 

Operations: Provider Network Manager (PNM) will oversee the day-to-day operations of managing the agency’s provider network. This includes ensuring providers maintain compliance per programmatic standards, ensuring the quality of services delivered, and supporting the network. PNM will have the responsibility to ensure the agency maintains an adequate network to deliver services, including the responsibility of negotiating direct service purchase (DSP) bids for in-home and community-based services for the entire agency. Manage and oversee a team that monitors, audits, and conducts surveys of the provider network. PNM must maintain current knowledge of all programs and have the ability to relay pertinent information to the provider network. PNM will facilitate provider network trainings and implement additional activities to support the network and improve provider relations.

Compliance/Quality: Provider Network Manager coordinates, manages and audits the provider network for compliance in accordance with all program funding streams. PNM will assess KPIs on a routine basis to ensure quality and timely service delivery. PNM will participate and take lead in all applicable internal and external assessments/audits that requires contribution from the department. PNM will ensure that all reporting is completed and met by deadlines according to program requirements. These may include but are not limited to reports related to OIG, provider assessment schedule, assessment findings and follow ups, network capacity, etc. PNM will work in collaboration with agency’s Compliance/Quality Department as needed.

Financial: Provider Network Manager will maintain knowledge of fiscal impacts related to reimbursement negotiation and collaborate with the Finance and Clinical teams as needed. PNM will collaborate with the Finance Department as needed related to provider claim resolutions as well.

Agency Representative: Provider Network Manager will act as a liaison with provider agencies to provide info on services, orientation/training, maintain relationships, and act as a liaison with internal and external stakeholders. PNM will attend external MDHHS meetings as necessary.

Duties Include:

• Oversee the day-to-day operations of managing the agency’s provider network. This includes ensuring providers maintain compliance with programmatic standards, ensuring the quality of services delivered, and supporting the network with training, programmatic updates and other information as required for provider network support. Supervise four Contract Coordinators responsible for provider groups.

• Coordinates, manages, and audits the provider network for compliance in accordance with all program funding streams. PNM will assess KPIs on a routine basis to ensure quality and timely service delivery. PNM is responsible for managing compliance performance issues and working with providers to meet requirements through a Compliance Assurance Process (CAP).

• Maintain knowledge of fiscal impacts related to reimbursement negotiation and collaborate with the Finance and Clinical teams as needed. PNM will collaborate with the Finance Department as needed related to provider claim resolutions as well.

• Act as a liaison with provider agencies to provide info on services, orientation/training, maintain relationships, and act as a liaison with internal and external stakeholders. PNM will attend external MDHHS meetings as necessary.
• Other duties as assigned (to view the entire job description, please select the "download" button).

Qualifications

QUALIFICATIONS:

• Bachelor degree in Business management, Administration or equivalent, Masters Preferred.
• Must have 5 years of relevant experience with contracts/project management and networking. Preferred experience with MiChoice, AASA, and ICO contracts.
• Excellent written, oral communication, organization, critical thinking and strong leadership skills.
• Ability to meet strict deadlines with a high level of accuracy.
• Strong negotiation skills, contract execution, computer skills in Word, Excel and Outlook required.
• Preferred certification in contracts management - CPCM, CFCM or CCCM.

OUR INDUSTRY-LEADING BENEFITS CONSISTS OF: 

Choice of 3 excellent next to zero cost Medical Plans including Dental and Vision. 

401K - Agency contributes 50% match up to first 6% contribution. 

Fitness and Wellness programs. 

Excellent PTO package- Minimum 4 weeks accrual for the first year. 

Get 10 paid holidays and 3 floating. 

Mileage reimbursed for business travel. 

Work schedules consist of hybrid, community-based, or office-based. 

Our recruiting team would love to hear from you today! Please complete our on-line application and submit your resume for immediate consideration.

The Area Agency on Aging 1-B is an Equal Opportunity and Affirmative Action Employer.