Job Description

1. Supervises a staff consisting of Network Management Associates both in house and remotely, and a Network Management Coordinator whose primary function is to provide provider support/education and interaction with contracted Health Plans (HMO and PPO).

2. Responsible for managing network provider education of applicable policies and procedures.

3. Responsible for supervising daily provider inquiries, including capitation and reimbursement issues.

4. Assist in development of physician communication programs and strategy.

5. Responsible for maintaining strong relationships with contracted Health Plans (HMO and PPO).

6. Communicates with payors and network providers, both orally and written, in association with operational and contractual related issues.

7. Oversees client related projects.

8. Assist in identifying issues, problems, and areas where performance could be improved.

9. Represent PPMSI at physicians offices, contracted health plans, and committees when necessary.

10. Develop and present educational pieces at network provider meetings.

11. Primary responsibility for periodic statistical performance reporting of Network Mgt activities.

12. Insure adequate physician network retention, expansion and recruitment.

13. Assist with the development of strategic plans for servicing network physicians and members.

14. Develop, recommend, and implement new policies and procedures when appropriate.

15. Play a key supportive role in Quality Initiatives.

16. In conjunction with the Vice President of Operations, provides supervisory assistance to the Network Management Contract Specialist and Credentialing Specialist

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com .

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Skills and Requirements

5 years of experience as a sales rep

  background in provider network mgmt

  marketing efforts

  provider education

  working with quality & working with the providers on this

  overseeing customer service

  communicating with payers on quality null

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal employment opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment without regard to race, color, ethnicity, religion,sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military oruniformed service member status, or any other status or characteristic protected by applicable laws, regulations, andordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or the recruiting process, please send a request to HR@insightglobal.com.