PROVIDER NETWORK MANAGER manages the operations of a healthcare provider network. Responsible for establishing and maintaining processes and systems to provide routine services to members including contract management and credentialing. Being a PROVIDER NETWORK MANAGER recruits, hires, trains, and measures performance of staff to provide effective and operations within budget. May be involved with the design and operations of database systems used to manage provider data and produce reports and analysis. Additionally, PROVIDER NETWORK MANAGER requires a bachelor's degree. Typically reports to top management. The PROVIDER NETWORK MANAGER typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. To be a PROVIDER NETWORK MANAGER typically requires 3+ years of managerial experience. (Copyright 2024 Salary.com)
This position is responsible for creating provider network reports for various regulators and quality monitoring organizations (DHS, CMS, MDH and NCQA). Responsible for the data populating UCare provider directories and online provider search. Collaborate with internal team members to ensure high quality and accurate provider data.
· Analyze and review provider demographic data for accuracy. Collaborate with provider data team to assess and monitor ongoing provider demographic data veracity. Leverage provider data massaging techniques to trend and identify patterns in the provider data and identify opportunities for improvement.
Education
Bachelor’s degree or equivalent in health care management or related field preferred; demonstrated work experience may be considered in lieu of degree.
Required Experience
One year of experience in a health delivery setting, such as physician group practice, health insurance, HMO or community service agency or one to three years of experience related to Health Plan operations. Demonstrated programming skills and experience may be considered in lieu of health care experience.
Preferred Experience
Experience with Analytical problem solving, long-term projects and data validation. Experience with Quest Analytics. Cactus, HealthRules, Amisys or credentialing and claims platform experience.
THE UCARE DIFFERENCE
The UCare difference is our people power – employees actively working on the behalf of our members to get them access to the health care they need. We value and respect each individual's ideas and contributions, and provide the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities. If you're looking for an inclusive environment that celebrates your people power, helps you build on your strengths and gives you the opportunity to truly make a difference, we invite you to apply.
As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.
JOB POST DATE: 4/7/2023