Network Management Specialist
Location: Raleigh, North Carolina US
Job Number: 2765
Position Title: Network Management Specialist
The Network Management Specialist will assist in building and maintaining high-performance provider networks by identifying opportunities to grow membership, contract with providers, and improve the contractual performance. Works closely with other departments to enhance the contracted provider experience consistent with company’s mission statement and values.
(May include but are not limited to)
- Supports efforts to improve Group/IPA financial performance by tracking and evaluating performance measures such as risk pool performance and bed day utilization and cost trends, identification, analysis and resolution of problem areas, communicating improvement requirements to providers/management team, and influencing provider to make systemic and operational improvements.
- Prepares supporting documentation, negotiates and implements contracts for physicians and ancillary providers for both existing and developing markets.
- Acts as technical resource on provider relations issues. Responsible for timely and professional interaction with internal and external customers.
- Enhances the relationship with provider organizations by organizing timely, effective Joint Operations Meetings and provider orientations, with appropriate data sharing, by efficiently and effectively responding to requests for information, by monitoring and influencing physician growth opportunities and trends, and by successfully resolving issues related to capitation, claims, and other operational functions.
- Assists other departments by sending out communication notices to external providers as well as distributing any documentation and performance measures to drive engagement.
- Utilizes understanding of the business risk relationships to interact and influence Physician Group Administrators and key physician leaders.
- Maintains internal awareness of network changes by issuing timely and accurate provider update communications about contractual risk disposition changes, provider terminations and additions, and panel closures.
- Ensures overall compliance by responding to grievances/appeals and adhering to regulatory and departmental Policy and Procedure guidelines and time frames.
- Maintains up-to-date, accurate provider database by overseeing proofing effort, prompt processing of PCP terminations with member reassignment, as well as group terminations in accordance with the Block Member Transfer P & P. Maintains understanding of physician affiliation patterns and trends, and the political/financial forces driving network movement.
- Promotes enrollment growth by supporting Marketing & Sales Department event planning and execution.
- Supports department efforts and Network Management Directors by participating in interdepartmental meetings and selected committees.
- Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
- Contributes to team effort by accomplishing related results as needed.
- Minimum Experience:
- Minimum 5+ years’ experience in provider relations/contracting with an HMO or IPA, medical group or institutional provider required, or a combination of education and experience may considered.
- Bachelor’s Degree preferred.
- Strong analytic, quantitative, and problem-solving skills required.
- Strong verbal and written communication skills required.
- Strong presentation skills and ability to appropriately and effectively address diverse audiences required.
- Proficiency in MS Word and Excel required; Access database proficiency preferred.
Conditions of Work
- Office Hours: Monday-Friday, 8am to 5pm. Extended work hours, as needed.
- 20-60% or more travel by car routinely required for Specialists.
- Travel by plan required as needed to support provider services needs in other geographies.
- Maintain reliable means of transportation. If driving, must have a valid driver’s license and automobile insurance.
Essential Physical Functions:
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 accommodations may be made to enable individuals with disabilities to perform the essential functions.
- While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
- The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
State: North Carolina
Location City: Raleigh
Location State: North Carolina
Community / Marketing Title: Network Management Specialist
Who is Alignment Healthcare?
- Socially responsible
- Technologically enabled
- Concierge care
- Servant leadership
We are dedicated to transforming the complex and confusing process of medical treatment in the United States so that every link in the health care continuum becomes more efficient, productive, and effective. We built a team of people who want to make a difference. Come join the team that is changing health care one person at a time.
We believe that great work comes from people who are inspired to be their best. We invite you to explore our wide variety of roles based on your unique experience.