Provider Network Specialist jobs in Dearborn Heights, MI

Under the supervision of the Director of Managed Care Operations, the Provider Network Manager is responsible for the overall coordination of the contracts between the Detroit Wayne Integrated Health Network (DWIHN) and the assigned network providers.

 PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Manages the contracts between (DWIHN) and the assigned network providers.  
• Serves as the primary liaison between the Network and the providers.
• Leads a “virtual team” of interdepartmental experts to assist, monitor and manage the network providers
• Collaborates with Finance, Information Technology, Recipient Rights, Quality Management, and Clinical Services to ensure that all contractual issues/concerns are addressed.  
• Serves as the providers primary point of contact with the Network. 
• Facilitates the successful implementation of new contracts with providers by providing technical assistance.
• Monitors, assesses and ensures that providers receive required and necessary training.
• Protects the confidential and proprietary nature of provider operations. 
• Explains and interprets the Network’s policies, procedures and goals to the provider network. 
• Resolves problems; responds to issues, requests and complaints; and answers questions for the provider network. 
• Collaborates with other Contract Managers to propose revisions to the Network’s policies and procedures to improve interface with network providers.
• Obtains and disseminates required provider network data for network development and maintenance. 
• Participates in the analysis of network provider performance data to ensure appropriate network utilization and identify needs for network modification and reconfiguration. 
• Facilitates provider network compliance and corrective action. 
• Responds to general public inquiries, problems and concerns. 
• Maintains documentation of all interactions with the provider network. 
• Submits monthly and quarterly written reports regarding provider network performance and progress. 
• Facilitates monthly/quarterly meetings with the provider network. 
• Prepares Board Actions as needed. 
• Monitors the contracting process from board action to approval. 
• Maintains oversight of the contracting process with network providers to ensure compliance with all procurement requirements.
• Performs related duties as assigned.

KNOWLEDGES, SKILLS AND ABILITIES (KSA’S)

• Knowledge of DWIHN policies, procedures and practices.
• Knowledge of the DWIHN provider network and community resources.
• Knowledge of the Michigan Mental Health Code.
• Knowledge of MDHHS policies, rules, regulations and procedures.
• Knowledge of Federal policies, rules, regulations and procedures as it relates to DWIHN.
• Knowledge of compliance standards.
• Knowledge of regulatory and industry best practice standards.
• Knowledge of Community Mental Health Services Programs (CMHSP) and Prepaid Inpatient Health Plans (PIHP).

• Management skills.
• Training skills.
• People management skills.
• Project management skills.
• Action planning skills.
• Conflict Resolution skills
• Corrective Action skills.
• Assessment skills.
• Organizational skills.
• Planning skills.
• Accuracy skills.
• Analytical skills.
• Time Management skills.
• Report writing skills.
• Negotiation skills.
• Interpersonal skills.
• Communication skills.
• Collaboration skills.
• Implementation skills.
• Teamwork Skills.
• Relationship-building skills.
• Computer skills (Word, Excel, Access, Power Point, Outlook, Teams)
• Ability to communicate orally.
• Ability to communicate in writing.
• Ability to work effectively with others.
• Ability to work with an ethnically, linguistically, culturally, economically and socially diverse population.
• Judgement/Reasoning ability.

REQUIRED EDUCATION:

A Bachelor’s Degree from a recognized college or university in the Human Services, the Social Services, Nursing, Public Health, Public Administration, Healthcare Administration, Health Management, Business Administration, or a related field.

REQUIRED EXPERIENCE:

Five (5) years of post-degree professional experience in behavioral healthcare or community mental health.  

Experience must include management, administrative or supervisory duties and responsibilities.

NOTE:  A Master’s Degree in the educational fields required by this posting may be substituted for two (2) years of the required experience.

REQUIRED LICENSE(S).

A valid State of Michigan Driver’s License with a safe and acceptable driving record.

WORKING CONDITIONS:

Work is usually performed in an office setting but requires the employee to drive to different sites throughout Wayne County and the State of Michigan.  This position can work remotely with supervisory approval.  Currently this position is primarily a remote position.

This description is not intended to be a complete statement of job content, rather to act as a general description of the essential functions performed.  Management retains the discretion to add or change the position at any time. 

Please Note:  DWIHN requires proof of being fully vaccinated for COVID-19 as a condition of employment. Medical or religious accommodations or other exemptions that may be required by law, will be approved when properly supported. Further information will be provided during the recruitment process. 

The Detroit Wayne Integrated Health Network is an Equal Opportunity Employer