Job Description
Job Description
The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
We are hiring a Network Manager to join our team!
Must reside in California - remote position.
What You Will Be Doing :
Under general supervision, responsible for negotiating, renegotiating, and implementing provider contracts that are fiscally and operationally sound.
Our Vision :
Continuously improve the health of our community.
Our Mission :
We provide healthcare value and advance wellness through community partnerships.
Essential Functions :
- Develops and fosters strong working relationships with the provider community which support provider satisfaction, medical cost targets, network growth and / or efficiency targets.
- Develops contracts and rate methodologies consistent with best practices, and division goals.
- Conducts analysis of proposed and existing contracts, including but not limited to financial impact, performance, sustainability, and access; makes recommendations and implements.
- Negotiates agreements within established parameters.
- Oversees contract implementation and administrative follow-through, including integration of contract acquisition and provider data maintenance activities. Oversees the identification, research, and resolution of contractual issues, including compliance, rates, reimbursement, and language interpretation.
- Develops an up-to-date and ongoing network analysis of provider network to include gaps and needs.
- Assists in developing contracting and provider network strategies, including identifying and recruiting new providers.
- Creates, maintains, and publishes periodic and ad hoc reports; arranges for distribution.
What You Bring :
Knowledge, Skills, Abilities and Competencies
Required
Produces work that is accurate and complete.Produces the appropriate amount of work.Actively learns through experimentation when tackling new problems, using both successes and failures to learn.Rebounds from setbacks and adversity when facing difficult situations.Knows the most effective and efficient process to get things done, with a focus on continuous improvement.In-depth knowledge of contracting reimbursement models (including DRG’s), structures, components, language, and payment methodologies.In-depth knowledge of the healthcare and managed care industry, its products, services, and major business processes.Basic knowledge of the regulatory guidelines governing network development and contracting in a managed care environment.In-depth knowledge of and skills in contract management systems. Basic knowledge of the business, economic, demographic, and political trends and developments affecting healthcare and managed care in general and contracting in particular.Strong negotiation skills, including a demonstrated ability to negotiate complex service levels and rates.In-depth knowledge of basic data analysis and communication / reporting tools and techniques, with ability to perform analysis and resolve problems of moderate complexity and recognize and act on trends.Interpersonal skills - interacts effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people.Strong oral and written communication skills, including the ability to communicate professionally and persuasively, and effectively explain complex information. Advanced presentation skills, including but not limited to the ability to tailor presentations to a specific audience, be persuasive and identify key messages.Strong listening skills, with the ability to accurately receive and understand messages. Strong facilitation skills, with ability to manage discussions among individuals from a variety of areas and levels to successful conclusion.Ability to work independently and as part of a team.Time management and organizational skills. Uses time effectively and efficiently. Values time. Concentrates his / her efforts on the more important priorities. Can attend to a broader range of activities. Meets deadlines.Demonstrates commitment to HPSJ’s strategy, vision, mission, and values.Basic skills in data visualization and narrative tools and techniques, with ability to position data effectively for consumption and action.Intermediate skills in Word, Excel, PowerPoint, Visio, and Outlook, including the ability to create complex formulas and templates.Ability to speak and be understood in English.Ability to handle confidential information with appropriate discretion.What You Have :
Education and Experience
Required
Bachelor’s Degree in Business, Public Health Administration or related.At least two years negotiating managed care contracts or equivalent combination of education and / or experience.Preferred
Experience negotiating and implementing contracts for government programs.Licenses, Certifications
What You Will Get : HPSJ Perks :
Competitive salaryRobust and affordable health / dental / vision with choices in providersGenerous paid time off (starting at 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays)CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution planTwo flexible spending accounts (FSAs)Employer-Paid Term Life and AD&D InsuranceEmployer-Paid Disability InsuranceEmployer-Paid Life Assistance ProgramHealth AdvocacySupplemental medical, legal, identity theft protectionAccess to exclusive discount mallEducation and training reimbursement in addition to employer-paid elective learning courses.A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do.A shorter commute – if you’re commuting from the Central Valley to the Bay Area.Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects.We are an equal opportunity employer and diversity is one of our core values. We believe that differences including race, ethnicity, gender, sexual orientation and other characteristics, will help us create a strong organization that is sensitive to the needs of those we serve. Employment decisions are made on the basis of qualifications and merit.
HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation or any other characteristic made unlawful by applicable Federal, State or local laws. It also prohibits unlawful discrimination based on the perception that anyone has these characteristics, or is associated with anyone who has or is perceived to have these characteristics.
Important Notice : This job description is not a contract between HPSJ and the employee performing the job. The duties listed in the job description may be changed at the discretion of HPSJ, and HPSJ may request the employee to perform duties that are not listed on the job description.
