Manager, Provider Network Operations (Healthcare)

Job Summary: The Manager of Network Operations is responsible for the general management of the Provider network as assigned by the Director of Network Operations. The position supports in achieving the strategic and development goals for the Network Operations department.

Essential Duties and Responsibilities:

· Manages the day-to-day activities of the Patient Care Coordinators.

· Oversees the provider credentialing process with Medical Groups and IPAs to ensure OPN Physicians are active. Also, responsible to ensure terminated Physicians are effectively terminated and transition of care efforts are followed.

· Responsible for New Provider and Staff Orientations and continued education of existing Providers to ensure company programs and processes are being effectively communicated and followed by the provider network.

· Facilitate health plan and medical group portal access for providers and staff.

· Manages and is accountable for the timely and appropriate resolution of provider and payer issues (i.e., claims, credentialing and operational).

· Perform on-site visits (as required) to physicians, physician groups and client medical groups within OPN’s service area.

· Manages the JOC process development, data gathering, reporting and analysis to provide JOC partners with current data related to provider performance.

· Responsible for the coordination, receipt, and review and processing of all provider contracts, credentialing, and provider correspondence to ensure the department has obtained proper signatures and documentation to effectively process newly recruited or existing providers.

· Ensures contract compliance of, and access to, provider network for all new and existing programs in given region as required by company policy and contracting Medical Group/IPAs.

· Assists the Director in the preparation of provider contractual agreements.

· Maintaining and updating the appropriate databases and department tools with current information.

· Supports and collaborates with Leadership Team and OPN departments.

· Assists the Director with projects, as necessary.

· Other duties as assigned.

Education and/or Work Experience Requirements:

· Bachelor’s degree in healthcare or related field, required.

· Master’s degree in health administration, required.

· 5 years of relevant work experience in Network Management, Contracting or Provider Relations in a managed care setting, health plan or large medical group administration.

· Knowledge of contracting principles/tools.

· Critical thinking and analysis.

· Excellent verbal and written communication skills.

· Proficient in MS Office programs (i.e., Word, Excel, Outlook, Power Point and Teams).

· Must be able to travel within service area and have a valid driver’s license and insurance.

· Oncology experience- preferred

· Excellent verbal and written communication skills, including ability to effectively communicate with internal and external stakeholders.