Provider Network Specialist jobs in Irvine, 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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Behavioral Health Utilization Manager
  • HERITAGE PROVIDER NETWORK
  • Orange, CA FULL_TIME
  • JOB SUMMARY:

                                                                                                                                                                                      

    The BH Case Manager manages, creates and fosters comprehensive behavioral health and chemical dependency, utilization/case management through a series of activities that comply with all applicable regulations and statutes in adherence with the PBHC Compliance Framework.

     

    1. ROUTINE:
    1. Know and follow Employee Handbook policies and procedures.
    2. Have excellent written and verbal skills.
    3. Maintain patient/employee confidentiality.
    4. Actively contribute to all staff meetings.
    5. Follow dress code.
    6. Notify supervisor in writing when requesting time off.
    7. Be courteous and demonstrate customer service skills.
    8. Be flexible and adaptable to any situation or duty.
    9. Promote departmental and organizational goals.
    10. Know and follow applicable safety standards.

     

    1. ESSENTIAL JOB FUNCTIONS:

     

    Work Position:

    1. Sitting - Frequency - 70% or more.
    2. Standing - Frequency - less than 25%.
    3. Walking - Frequency - less than 25%.
    4. Driving – Frequency – 25% or more
    5. Travel – Frequency – 10% or more

     

    Body Movements:

    1. Lifting - 0-20 lbs; books, reams of paper, files, etc. - Frequency - approximately 20%.
    2. Bending, stooping and squatting - Frequency - approximately 15%.
    3. Reaching above head to 75 degrees - Frequency - approximately 15%.
    4. Hand/grip dexterity - Frequency - approximately 50%.

     

    1. SPECIFICS: (100% of time is dedicated to PBHC) 
    1. Identifies patients meeting Chemical Dependency and/or Behavioral Health criteria to be placed in the Behavioral Health and/or Chemical Dependency case management program under the behavioral health management system through Utilization Review meetings, Primary Care Physicians/Provider notification, medical case management referral, risk stratification, medical records review, and data analysis.
    2. Complete triage assessments to determine appropriate program referral. Refer patients to appropriate providers and programs including but not limited to PHP/IOP.
    3. Utilization Management and/or collaboration of inpatient admissions
    4. Intensive case management of chemically dependent and SPMI (Seriously and Persistently Mentally Ill) population.
    5. Complete care authorizations as necessary
    6. Work with physician providers and ancillary personnel to establish the appropriate monitoring schedule needed for patients in the program.
    7. Management/monitoring of Behavioral Health/Chemical Dependency patients to include daily/weekly/monthly phone calls as per established criteria, post-hospital follow-up/discharge phone call and direct contact in clinics/hospital/skilled nursing facility/home.
    8. Communicate with the primary care physician and nursing staff to assure appointments are being kept and the overall treatment plan is being adhered to.
    9. Communicate with member, members’ family and caregivers to ensure appointments are being kept, medications are being filled and taken, and the overall treatment plan is being adhered to.
    10. Maintain a collaborative relation with the medical group and health plan staff to ensure patient education, referrals for appropriate trainings and other avenues/efforts to assist in patient compliance.
    11. Works as liaison between in-patient and outpatient delivery systems to ensure continuity of care.
    12. Maintain computerized tracking systems and databases.
    13. Generate various reports to constituents as appropriate.
    14. Compile statistics and generate various reports to constituents as requested
    15. Actively participate in Interdisciplinary Care Team meetings by presenting appropriate Chemical Dependency and Behavioral Health cases for discussion and contribute at meetings to promote total case management.
    16. Assist department supervisor/case managers as directed.
    17. Assist with reviews and updates on quality, utilization, and member management policies and procedures.
    18. Other duties as assigned.

    The pay range for this position at commencement of employment is expected to be between $29.00/hour to $38.00/hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

    The total compensation package for this position may also include other elements, including a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

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Inpatient LVN Case Manager
  • HERITAGE PROVIDER NETWORK, INC.
  • Orange, CA FULL_TIME
  • Position Summary: The Inpatient Case Manager is responsible for the assessment, treatment planning, intervention, monitoring, evaluation and documentation on identified patients during an acute care e...
  • 8 Days Ago

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Provider specialist
  • Regal Medical Group
  • Orange, CA FULL_TIME
  • Job Description Position Summary : This position will serve as a primary contact to members whose Primary Care Physician (PCP) terminates with our IPA / Medical Group. The individual will conduct outb...
  • 20 Days Ago

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Provider Relations Specialist
  • CareConnectMD, Inc
  • Costa Mesa, CA FULL_TIME
  • Responsible for engaging partner providers and facilities on a variety of patient Experience, Quality, Risk Adjustment activities. These activities include liaising with partner provider and facilitie...
  • 21 Days Ago

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Provider Support Specialist
  • REGAL MEDICAL GROUP, INC
  • Orange, CA FULL_TIME
  • Position Summary: This position will serve as a primary contact to members whose Primary Care Physician (PCP) terminates with our IPA/Medical Group. The individual will conduct outbound calls to educa...
  • 1 Day Ago

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Network Manager/ Vietnamese Speaking (Provider Relations Orange County)
  • REGAL MEDICAL GROUP, INC
  • Orange, CA FULL_TIME
  • Position Summary: The Network Manager is responsible for general management of the provider network as assigned by the Director of Network Management as well as for supporting the Network Management D...
  • 12 Days Ago

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0 Provider Network Specialist jobs found in Irvine, CA area

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Network Engineer
  • The Intersect Group
  • Torrance, CA
  • Position: Network Engineer Salary: 130-145K Location: Torrance, CA MUST HAVE ACTIVE NETWORK CERTIFICATION Description: Y...
  • 3/28/2024 12:00:00 AM

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Sr Network Engineer
  • MetroSys
  • Irvine, CA
  • Responsibilities: Lead the design, implementation, and maintenance of complex network solutions utilizing Cisco, Juniper...
  • 3/28/2024 12:00:00 AM

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Senior Network Engineer
  • Prosum
  • Buena Park, CA
  • CTH role for 3-6 months. On-site two days a week in Buena Park, probably Tuesday and Wednesday. Some flexibility on actu...
  • 3/27/2024 12:00:00 AM

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Sr Network Engineer
  • Prosum
  • Buena Park, CA
  • Skills/experience needed: At least 7 years as a Sr. Network Engineer with 10-20 years overall of hands-on experience con...
  • 3/27/2024 12:00:00 AM

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Network Engineer
  • The Intersect Group
  • Santa Ana, CA
  • Job Title: Network Engineer Schedule: Monday-Friday 8am-5pm Duration: 6-month contract, possibility of extension or conv...
  • 3/26/2024 12:00:00 AM

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Network Engineer
  • M-Theory Group
  • Los Angeles, CA
  • Level 1 IT Support Technician Join our team of IT professionals and provide technical support to our clients. Job Descri...
  • 3/25/2024 12:00:00 AM

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Network Engineer
  • The Intersect Group
  • Torrance, CA
  • Job Title: Network Engineer Schedule: HYBRID 3 days on-site, 2 days remote: Monday-Friday 8am-5pm Duration: Full-time op...
  • 3/24/2024 12:00:00 AM

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Network Engineer
  • New-Indy Containerboard LLC
  • Ontario, CA
  • Position Title: Network Engineer Role Summary: The Network Engineer is responsible to ensure the stability and integrity...
  • 3/24/2024 12:00:00 AM

Irvine (/ˈɜːrvaɪn/) is a master-planned city in Orange County, California, United States in the Los Angeles metropolitan area. The Irvine Company started developing the area in the 1960s and the city was formally incorporated on December 28, 1971. The 66-square-mile (170 km2) city had a population of 212,375 as of the 2010 census; in 2018 the California Department of Finance estimated the city's population at 276,176. A number of corporations, particularly in the technology and semiconductor sectors, have their national or international headquarters in Irvine. Irvine is also home to several hi...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Network Specialist jobs
$65,582 to $98,076
Irvine, California area prices
were up 3.0% 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