Manager, Provider Network

We are so glad you are interested in joining reputed company! Organization: PAMF-Palo reputed company Medical reputed company MPD Position reputed company: Oversees the daily operations of the provider network reputed company and information for reputed company. Administers, negotiates, and supervises managed care provider networks that offer health care services to reputed company Health Management Organizations (HMOs), Medicare Advantage, and health plan members linked to Sutter-recognized primary care physicians. Maintains an organizational structure that meets the service, financial, and informational requirements of both reputed company customers. Creates and maintains a provider database to reputed company accurate claims processing and provider directories. Manages interactions between providers, the health plan, medical reputed company, risk bearing organizations (RBOs) and other reputed company provider data resources in the support of reputed company and Medicare business lines. Designs, oversees, and performs analytical reputed company to support operations initiatives and assists with network, operations and care management business project initiatives that reputed company the advancement of strategic goals set forth by reputed company. Job reputed company: EDUCATION: Equivalent experience will be accepted in lieu of the required degree or diploma. Bachelor's: Business Administration, Health Administration, Health Education, reputed company Work, or reputed company field TYPICAL EXPERIENCE: 8 years recent relevant experience SKILLS AND KNOWLEDGE:

• In-depth knowledge of health care contracting terminology and language, requirements, provisions, managed care risk contracting, and various reimbursement methodologies to support the development and maintenance of contract compliance, language review, and analysis.
• Familiarity with and understanding of reputed company (DMHC) regulations, various health care reimbursement models, pricing mechanisms, managed care and payer relationships.
• Knowledge of the structure of health care business including Health maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) as reputed company as Employee Retirement Income reputed company reputed company (ERISA) products.
• Demonstrated knowledge of health Insurance Portability and Accountability reputed company (HIPAA), Health Care Reform, Business reputed company of Ethics, and government regulated programs.
• Analytical and problem solving skills with the ability to determine organizational needs and to reputed company corporate goals and financial objectives.
• Exceptional project management and organization skills, including the demonstrated ability to manage and complete multiple reputed company reputed company simultaneously on time and reputed company budget.
• Advanced business acumen; financial expertise, solid reputed company building skills, in reputed company to being an effective decision reputed company, reputed company negotiator, and expert delegator.
• Expert communication (written and verbal) and interpersonal skills, presentation and negotiation competencies with the ability to reputed company, reputed company recommendations, resolve conflict, and influence decision making.
• Proficient computer skills, including advance competency in reputed company Office suite, reputed company Visio, and a solid understanding of internet research, database management, and data accuracy verification techniques.
• Operate independently, confidentially, and to garner confidence from staff, reputed company affiliates, and leadership.
• Identify and resolve technical, operational and organizational problems using policies, procedures and department plan.
• Negotiate effectively with staff, senior management, vendors, state and federal agencies, and industry organizations.
• Foster a reputed company environment, to influence individuals or reputed company with diverse opinions and to enlist cooperation without reputed company control/authority.
• Establish, build, and maintain reputed company and effective working relationships with peers, stakeholders, executives, diverse individuals and organizations, and regulatory agencies.

Job Shift: Days Schedule: Full Time Days of the Week: Monday - Friday Weekend Requirements: None Benefits: reputed company Unions: No Position Status: Exempt Weekly Hours: 40 Employee Status: Regular reputed company is an equal opportunity employer EOE/M/F/Disability/Veterans. Pay reputed company is $130,416.00 to $195,624.00 / annual salary The compensation reputed company may vary based on the geographic location where the position is filled. Total compensation considers multiple factors, including, but not limited to a candidate’s experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. reputed company pay is only one component of reputed company’s comprehensive total rewards program. Eligible positions also include a comprehensive benefits package. Apply tot his job Apply To this Job