Supervisor of Provider Network Operations

Description

Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California’s fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.  

Who Are We? ✨ 

Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members’ culture and values. 

Why Join Us? 🏆

We’re on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation. 

Job Summary

The Supervisor of Provider Network Operations leads all back-office operations in Network Management.  This includes the maintenance for day-to-day contract administration and operations, maintaining a comprehensive filing system for all contracts and amendments, and the administrative tasks that surround those files, including the onboarding of new providers (and offboarding of terminated providers), and coordinating with internal departments the information that passes thru Network Management.  Supports the Provider Relations Field Representative to achieve department goals. Responds to customer service and provider relations inquiries from providers and assist with problem resolution of issues. Coordinate’s provider submissions to internal departments via required forms.  Supervises internal network management operations staff.

Functions & Job Responsibilities

• Function as Lead responsible for day-to-day contract administration and operations for Provider Network Management.
• Coordinate and oversee contract submissions for participating Physician Groups, IPAs, Hospitals, Individual, and Ancillary providers.
• Responsible for the maintenance ,implementation and execution of new and renewed provider contract agreements through communication and coordination with internal departments.
• Oversee the Provider Relations email box and Provider Relations Support Line.
• Assist the team in fulfilling department responsibilities and collaborate with others to support request for special projects short- and long-term goals for the department.
• Responsible for managing, hiring, and training of new Network Operations Associates.
• Coordinate and track provider Letters of Agreement and Memoranda of Understanding.
• Build provider awareness of and engagement with Clever Care Health Plan
• Proactive research and resolution of provider issues including but not limited to claims submission, processing, and payment; contracting details; provider tools; and UM and other protocols.
• Works directly with internal and external partners to collect all required information to ensure correct processing of contracts, amendments, and update requests.
• Works with delegated providers and IPAs to process new provider load requests along with any updates or changes within the group via a roster methodology.
• Performs root cause analysis of delays in provider loading and assists in bringing to resolution.
• Achieves call reach and frequency goals to establish consistent and strong relationship with provider offices.
• Ensure accurate ongoing collection of key provider data element updates and changes.
• Provides oversight on inquiries and claims issues and follows up with providers to ensure problems have been resolved.
• Strategizes for membership growth and retention.
• Collaborate with Marketing, Sales, Provider Data, Credentialing, Operations, and other teams to coordinate cross-functional in-market activities.
• Oversee the Provider Onboarding process ensuring proper steps are followed from Credentialing to the Provider final configuration
• Provide high level of customer service.
• Other duties as assigned.

Leadership Expectations

By way of leadership approach, mobilize others to create extraordinary results, and unite people to turn challenges into successes by championing the following:

1. Model the Way:

• Clarify values by finding your voice and affirming shared values
• Set the example by aligning actions with shared values

2. Inspire a Shared Vision

• Envision the future by imagining and sharing exciting possibilities
• Enlist others in a common vision by appealing to shared ambitions

3. Challenge the Process

• Search for opportunities by seizing the initiative and looking outward for innovative ways to improve
• Experiment and take risks by consistently generating small wins and learning from experience

4. Enable Others to Act

• Foster collaboration by building trust and facilitating relationships
• Strengthen others by increasing self-determination and developing competence

5. Encourage the Heart

• Recognize contributions by showing appreciation for individual excellence
• Celebrate the values and victories by creating a spirit of community

Qualifications

Qualifications

Education and Experience

• Associate degree in a related field

• Three (3) or more years’ experience in the healthcare industry
• Three (3) years of navigating relationships around providers and insurance networks is preferred.

Skills

• Must be detail-oriented.
• Must be highly organized.
• Demonstrated ability to manage multiple projects and meet deadlines

• Strong communication and presentation skills with ability to effectively communicate with all levels of the organization, internally and externally

• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Wage range: $70,000.00/yr - $80,000.00/yr

Physical & Working Environment.

Physical requirements needed to perform the essential functions of the job, with or without reasonable accommodation:

• Must be able to travel when needed or required  
• Ability to operate a keyboard, mouse, phone and perform repetitive motion (keyboard); writing (note-taking)
• Ability to sit for long periods; stand, sit, reach, bend, lift up to fifteen (15) lbs.

Ability to express or exchange ideas to impart information to the public and to convey detailed instructions to staff accurately and quickly.

Work is performed in an office environment and/or remotely. The job involves frequent contact with staff and public. May occasionally be required to work irregular hours based on the needs of the business.

Clever Care Health Plan is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

Salary ranges posted on the job posting are based on California wages. Salary may be higher or lower depending on the candidate’s state residency

Salary : $70,000 - $80,000