What are the responsibilities and job description for the Provider Network Manager- San Diego position at Prospect Medical Group?
The Network Manager will manage assigned territory at a level to meet company objectives. Duties and responsibilities will include developing and maintaining relationships with assigned physicians, overseeing compliance with identified revenue-driven initiatives, and identifying, pursuing, and growing new membership and business opportunities.
Responsibilities
- Conduct routine visits to all providers as outlined in department policies to ensure performance compliance with revenue-driven initiatives and focus on goals.
- Identify opportunities to achieve membership growth by developing and capitalizing on relationships with physicians and pursuing business opportunities to support companywide revenue goals.
- Maintain positive business relationships to ensure retention of existing providers, therefore, decreasing the potential membership loss due to provider terminations.
- Oversee the compliance and participation of network physicians to ensure providers are responding timely and accurately to global requests made by any and all departments within our organization.
- Comply with production reporting requirements as stated in Department Policies and Procedures by required time frame.
- Work well and develop relationships with Provider Relations Support Staff and other departments to effectively resolve issues that require root cause resolution from individuals within Prospect Medical. Supervise, train, and mentor new Network Managers to meet department and company objectives.
Qualifications
Minimum Education : High School graduate or equivalent. Four (4) year college degree preferred.
Minimum Experience : Minimum of three (3) years of HMO / IPA experience in Provider Contracting. Previous supervisory experience preferred.
Req. Certification / Licensure : None.
About Us
With approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas, and Rhode Island. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services. Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. For 25 years, Prospect Medical has been focused on our mission of supporting independent physicians where, through risk arrangements, we work closely together with health plans, facilities, and healthcare physicians for the benefit of every person who comes to us for care. We provide quality healthcare services that are designed to offer our patients highly coordinated, personalized care and that help them live healthier lives. Prospect Medical Systems manages highly successful IPAs by leveraging our best practices and results-driven administrative services to manage patients under risk arrangements with health plans / CMS.
Job Info
J-18808-Ljbffr