Provider Network Manager - Orange County

POSITION SUMMARY

The Provider Network Manager is responsible for developing and retaining business and providing excellent service to clients in the specified geographic region. The ideal person will have proven experience building on existing relationships, eliminating competitive threats within our network base, and ensuring satisfaction within our accounts.

ESSENTIAL DUTIES AND RESPONSIBILITIES

To perform this job, an individual must perform each essential function satisfactorily, with or without reasonable accommodation, including, but not limited to:

• Generates and develops new business to meet specified production goals.
• Maintains and nurtures existing client relationships.
• Responds to all inquiries and requests in a timely and professional manner.
• Functions as liaison between client companies and operations staff.
• Understands and communicates information regarding company products, services, and policies and procedures to new and existing clients.
• Possesses and maintains thorough knowledge of Medicare Advantage Plan product information.
• Continually gathers information on local competition and prevalent industry and business climate within the region; communicates information to management and others as needed.
• Works with more complex providers. Complex providers may include, but are not limited to large institutional providers, and large medical groups, value-based concepts understanding and support, providers in areas with strong competition or where greater provider education around managed care concepts is required.
• Conducts more complex negotiations and drafts documents.
• Ensures that all required client paperwork is complete, accurate, and submitted on time.
• Provides timely and accurate reports as required.
• Strong background in value based/full risk PCP MSO/IPA arrangements related to Medicare Advantage and other governmental programs.
• Attends and participates in business/trade events that impact business unit.
• Attends and participates in team strategic sales meetings.
• Performs other related duties as assigned by management.

SUPERVISORY RESPONSIBILITY

People Leadership

• Yes.

QUALIFICATIONS AND EDUCATION

Required Qualifications

• Bachelor's degree (B. A.) or equivalent, 6 years of experience, or equivalent combination of education and experience.
• 5 years of experience in value based contract agreement (care).
• Bilingual in Spanish preferred
• 5 years Medicare Advantage Plan.
• Provider Network experience.
• Must be a self-starter and proactive.
• Commitment to excellence and high standards.
• Excellent written and verbal communication skills.
• Good judgement with the ability to make timely and sound decisions.
• Creative, flexible, and innovative team player.
• Demonstrated ability to make successful presentations to individuals and/or groups at all levels of an organization.
• Strong organizational skills; able to manage priorities and workflow.
• Ability to work independently and as a member of various teams and committees.
• Ability to calculate figures and amounts such as discounts, interest, commissions, and percentages.
• Excellent problem resolution and consultative sales skills.
• Proven ability to handle multiple projects and meet deadlines
• Strong interpersonal skills.
• Ability to prepare reports and business correspondence.
• Versatility, flexibility, and a willingness to work within constantly changing priorities with enthusiasm.

WORKING CONDITIONS

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

• The noise level in the work environment is usually moderate.
• Works in the field
• Interacts with patients, family members, staff, visitors, government agencies, etc., under a variety of conditions and circumstances.

This work requires the following physical activities: climbing, bending, stooping, kneeling, reaching, sitting, standing, walking, lifting, finger dexterity, grasping, repetitive motions, talking, hearing and visual acuity. The work is performed indoors. Sits, stands, bends, lifts, and moves intermittently during working hours. May be sitting for a prolonged period.

The work schedule is approximate, and hours/days may change based on company needs. All full-time employees are required to complete forty (40) hours per week as scheduled, including weekends and holidays as needed. May require some OT during varying seasons of the year.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

The employee must be able to frequently lift up to 10 pounds and occasionally lift and/or move up to 25 pounds. While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to stand and walk. The employee is occasionally required to use hands to finger, handle, or feel; reach with hands and arms; climb or balance and stoop, kneel, crouch, or crawl. Specific vision abilities required for this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

PERFORMANCE MEASUREMENTS

• Duties accomplished at the end of the day/month.
• Attendance/punctuality.
• Compliance with Company regulations.
• Safety and Security.
• Quality of work.

This Job Description may be modified at any time at the discretion of the employer as business operations may deem necessary. This does not constitute an employment agreement and may not include all duties.

The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required of personnel so classified. The incumbent must be able to work in a fast-paced environment with a demonstrated ability to juggle and prioritize multiple competing tasks and demands and to seek supervisory assistance as appropriate.