Provider Network Specialist jobs in Fresno, CA

Provider Network Specialist coordinates and evaluates the contracts of a healthcare provider network. Participates in the negotiation of contracts and prepares reports and analysis of contract details and statistics. Being a Provider Network Specialist distributes contract information, status updates, and other information within the organization. Requires a bachelor's degree. Additionally, Provider Network Specialist typically reports to a manager or head of a unit/department. The Provider Network Specialist gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Provider Network Specialist typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)

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Provider Network Development Manager
  • Central California Alliance for Health (Remote)
  • Mariposa, CA FULL_TIME
  •  

    We have an opportunity to join the Alliance as the Provider Network Development Manager within the Provider Services Department, leading the Provider Network Development team. This position will require regular and ongoing travel within Alliance service counties. 

     

    ABOUT THE JOB 

    The Provider Network Development Manager is a new role at the Alliance and will lead a team focused on ongoing recruitment and development of a robust provider network. With upcoming changes in the management of Behavioral Health services as well as standing up a Medicare D-SNP program beginning in 2026, the Provider Network Development Manager will lead the strategic recruitment efforts in building an integral provider network to support those programs. This role will work cross-functionally, collaborating with the Alliance’s Provider Relations and Contracts teams and other departments within the organization.  

     

    WHAT YOU'LL BE RESPONSIBLE FOR

    Reporting to the Provider Services Director, this position: 

    • Manages, plans, implements, and leads provider network development strategy
    • Manages and leads provider recruitment efforts
    • Manages and leads the Provider Network Development Unit, acts as a subject matter expert, provides guidance on unit functions and departmental operations
    • Manages, supervises, mentors, and trains assigned staff

     

    THE IDEAL CANDIDATE 

    • Understands network adequacy standards and has a proven track record of developing and executing effective provider recruitment strategies, particularly Medicare D-SNP and/or Behavioral Health providers 
    • Knowledge of providers within Alliance service counties (Mariposa, Merced, Monterey, San Benito, and/or Santa Cruz) 
    • Knowledge and understanding of provider contract negotiations 
    • Exceptional verbal communication skills, with strength in relationship building and influencing others through professional conversations 
    • Thrive in matrix management environment 
    • Adept at leading and collaborating with cross-functional teams 
    • Demonstrated ability to manage competing priorities, aligning them strategically with the company's objectives for optimal efficiency and success 
    • Seasoned leader, with demonstrated experience managing staff, including employee relations and fostering a positive workplace culture, coupled with a track record of driving staff development through mentorship, training, and performance management strategies 
    • Strength in developing efficient processes and workflows, knowing when and how to best implement process improvements initiatives  
    • Energized by regular-cadenced, face-to-face engagement with local providers to cultivate interest in contracting with the Alliance  

     

    WHAT YOU'LL NEED TO BE SUCCESSFUL

    To read the full position description, and list of requirements click here

    • Knowledge of:
      • The healthcare delivery systems, including hospitals, clinics, and other healthcare provider types
      • The California Medi-Cal program entitlement programs, and related regulations
      • The principles and practices of provider network evaluation, analysis, and reporting
      • Provider contract negotiation and contract management principles, including reimbursement rates, service level agreements, and performance metrics
      • Principles and practices of program and project management
    • Ability to:
      • Analyze provider network performance, identify gaps, and develop strategies for improvement
      • The development, implementation, and management of projects, programs, systems, policies, and procedures
      • Train, mentor, supervise, and evaluate the work of staff, promote an atmosphere of teamwork and cooperations, and motivate staff to achieve goals and objectives
      • Provide leadership, facilitate meetings, and present information, data, and results in a clear and understandable manner utilizing methods appropriate to various forums
      • Present strategic information, data and results in a clear and understandable manner utilizing methods appropriate to various forums
    • Education and Experience:
      • Bachelor’s degree in Healthcare Administration, Business Administration, Social Science, or a related field
      • A minimum of six years of experience in managed care, which included a minimum of three years of supervisory or management level experience related to provider network development, provider relations, and/or provider contract negotiations (a Master’s degree may substitute for two years of the general managed care experience); or an equivalent combination of education and experience may be qualifying

     

    OTHER DETAILS

    • While this position is connected to one of our Alliance offices, we are in hybrid remote/in-office work environment right now and we anticipate that the interview process will take place remotely.
    • Our Alliance office locations have officially re-opened after the pandemic and while some employees may work in full-time telecommute schedules, attendance at quarterly company-wide events or department meetings will be expected.
    • Based on the nature of work, this position will require regular travel within Alliance service counties, which is dependent on business need. Details about this can be reviewed during the interview process.

     

    The full compensation range for this position is listed by location below. 

    The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).

  • 1 Month Ago

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Network Support Specialist
  • Kotman Technology
  • Fresno, CA FULL_TIME
  • We are looking to hire a Team Member who loves working with and helping people but who also loves working with technology. You must possess excellent communication skills, work well in a team and know...
  • 1 Month Ago

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Provider Enrollment Specialist
  • Community Medical Centers of Fresno, CA
  • Fresno, CA OTHER
  • Overview *All positions are located in Fresno/Clovis CA* At Community Health System, we know that our ability to provide the highest level of care begins with our incredible staff. From unique supplem...
  • Just Posted

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Dentist - Great Pay and Benefits
  • Provider Healthcare
  • Le Grand, CA FULL_TIME
  • Job Type Full Time Schedule Days Pay $160 - $176k plus bonuses Patients Per Day EMR System - Epic Work Location Clinic, All Ages Job ID 60466 Job Description A La Grand, California based client is loo...
  • Just Posted

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Nurse Practitioner
  • Provider Healthcare
  • Le Grand, CA FULL_TIME
  • Job Type Full Time Schedule - Days Pay Depends on Experience Patients Per Day EMR System - Epic Work Location All Ages; Outpatient Job ID 60329 Job Description A Le Grand, California based client is s...
  • 1 Day Ago

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Dentist Needed Excellent Pay and Benefits Le Grand, California
  • Provider Healthcare
  • Le Grand, CA FULL_TIME
  • Job Type Full Time Schedule M-F 8-5 Pay Depends on Experience Patients Per Day 18-20 EMR System - Epic Work Location Clinic Job ID 60336 Job Description A Le Grand based client is searching for an exp...
  • 1 Day Ago

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0 Provider Network Specialist jobs found in Fresno, CA area

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Information Professional
  • US Navy
  • Fresno, CA
  • About In the Navy, information technology (IT) plays an important role in everything from electronic mail systems, to sh...
  • 3/29/2024 12:00:00 AM

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IT Specialist
  • West 4th Strategy
  • Fresno, CA
  • IT Specialist ROLE We need an IT Specialist for the United States Attorneys Office, Eastern District of California (USAO...
  • 3/28/2024 12:00:00 AM

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Technical Support Specialist
  • CIO Solutions
  • Fresno, CA
  • About us: CIO Solutions provides premium IT services to small and large businesses, affordable housing developments, med...
  • 3/28/2024 12:00:00 AM

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IT Support Specialist
  • Matian Firm
  • Fresno, CA
  • **IT Support Specialist** at The Matian Firm, APC Fresno, CA Our firm is looking to add an **IT Support Specialist** to ...
  • 3/27/2024 12:00:00 AM

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Network Technician
  • VAST Networks
  • Fresno, CA
  • Job Description Job Description Job description Internet Service Provider located in Fresno California is looking for a ...
  • 3/26/2024 12:00:00 AM

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Network Engineer
  • Mds (micro-data Systems)
  • O Neals, CA
  • Network Engineer The Network Engineer will have a mastery of the fundamental connectivity and inner workings of the netw...
  • 3/25/2024 12:00:00 AM

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Technical Support Specialist
  • BellwetherIT
  • Fresno, CA
  • Job Description Job Description Technical Support Specialist at Bellwether IT About us: Since 2008, Bellwether has been ...
  • 3/25/2024 12:00:00 AM

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Remote Sales Associate - Part-Time & Full-Time Opportunities Available!
  • Symmetry Financial Group
  • Fresno, CA
  • Job Description Are you ready to take charge of your career in sales? The Spivey Agency is seeking motivated individuals...
  • 3/25/2024 12:00:00 AM

Fresno (/ˈfrɛznoʊ/ FREZ-noh; Spanish for "ash tree") is a city in California, United States, and the county seat of Fresno County. It covers about 112 square miles (290 km2) in the center of the San Joaquin Valley, the southern portion of California's Central Valley. Named for the abundant ash trees lining the San Joaquin River, Fresno was founded in 1872 as a railway station of the Central Pacific Railroad before it was incorporated in 1885. The city has since become an economic hub of Fresno County and the San Joaquin Valley, with much of the surrounding areas in the Metropolitan Fresno regi...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Network Specialist jobs
$58,936 to $88,137
Fresno, California area prices
were up 2.7% from a year ago

Provider Network Specialist in Springfield, MO
As the liaison between provider and the health plan, candidates are tasked with ensuring improved revenue generated and patient quality score.
December 16, 2019
Provider Network Specialist in Stamford, CT
Previous experience in a network development, provider recruitment or provider contracting.
December 04, 2019
Provider Network Specialist in Fort Wayne, IN
In this position, employees will be expected to perform benefits analysis and create reports on provider performance to support the needs of the analysis found.
January 18, 2020