UPMC University of Pittsburgh Medical Center

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Network Manager - North Central (Hybrid)

DuBois, PA, US • Posted 13 hours ago • Updated 43 minutes ago

Full Time

On-site

Fitment

Dice Job Match Score™

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Job Details

Skills

Recruiting
Network Administration
Authorization
Licensing
Billing
Impact Analysis
Collaboration
Medicaid
Facilitation
Presentations
Regulatory Compliance
Workflow
Management
Sales
Health Care
Network
Leadership
Communication
Documentation
Analytical Skill
Problem Solving
Conflict Resolution
Finance
Forecasting

Summary

UPMC Community Care Behavioral Health is hiring a full-time Network Manager to support the North Central Network Management team. This position follows a hybrid schedule, requiring in-office presence 3 days per week - Monday, Wednesday and Thursday. Candidates may work from any of the following office locations: Dubois, Moosic, or State College. Occasional travel will be required.

The Manager, Network leads a team of professionals to work in collaboration with network providers to ensure delivery of high quality, cost efficient behavioral healthcare services to mutual customers of Community Care. Establishes goals for the department that lead to not only the department's success, but also the overall success of Community Care. Interacts with other internal and external customers to set appropriate goals and establish priorities for the Network Management staff. Prepares and organizes deliverables required for the assigned network(s)

Responsibilities:

In collaboration with Senior Director Network and Regional Director, recruit, train, supervise and evaluate staff assigned to contract.
Conduct Individual Provider Orientation/Service meetings to review Authorization procedures, billing requirements as well as a review of Member rights/responsibilities.
Investigate Licensing Regulations and/or HealthChoices Regulations when presented with provider specific questions.
Prepare all network agenda items for clinical-operations meetings and follow through with any required action items.
Serve as the point person for all provider related inquiries (with the exception of direct claims related questions). This includes, but is not limited to, issues related to the following:Credentialingnetwork expansionfee schedulesregulationsAllowable billing activitiesPROMISe related matters
Prepare all contract related network deliverables, including but not limited to Geo-Access reports and waivers, RAI/PEPS information and any on-going monitoring of network activity.
Oversee all network expansion activities for new and existing providers including the following: Developing financial impact analysis Obtaining verification of specialization Reviewing information at Clinical Operations Meeting Reviewing credentialing information Submitting Supplemental Service Enrollment Applications to the State on behalf of the Provider Assist Providers in Service Description Development
Coordinate problem resolution for providers as necessary and ensure ongoing collaboration with providers to support Community Care initiatives.
Collaborate consistently with Regional Director to prepare for and present network updates at OMHSAS monitoring meetings.
Develop written communication following provider meetings in which quality of care concerns are discussed.
Participate in meetings with the County Administration (and/or HealthChoices oversights) who are the direct contract holders for the Medicaid contract with the state.
Ensure ongoing provider communication through the facilitation of Provider Advisory Committee Meetings (including responsibility for the following: creating agenda, presenting information, leading discussion) to large groups of providers in the respective contracts.
Participate and prepare materials for Office of Mental Health and Substance Abuse (OMHSAS) Monitoring Meetings
Oversee daily activities of staff to ensure compliance with workflows and timeframes

Qualifications:

Bachelor's Degree in business, health care, management, or a related field is required.
3 years of business/sales or healthcare related experience required.
- Preference will be given to those with prior provider experience.
Ability to forge strong interpersonal relationships within the department, other departments, and with the physician network.
Strong leadership, planning, communication, documentation, organizational, analytical, and problem-solving abilities.
Ability to interpret and summarize results of various analyses in a timely manner.
Ability to re-engineer processes to positively impact the performance of the department and Community Care, as well as individual provider offices.
Ability to analyze financial and clinical results and to comprehend forecasting models.
Licensure, Certifications, and Clearances:
Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran

Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.

Dice Id: RTX16be38
Position Id: 65abfa331ab30d2ff76e083e417420e6
Posted 13 hours ago

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