Workers' Compensation Manager jobs in Pennsylvania

UPMC's Health Plan and Workpartners are hiring a Network Manager for its Workers Compensation Case Management team.

This is a remote position but will require 15% travel and may require travel to Pittsburgh for meetings and trainings.

The Network Manager is responsible for the expansion of the Workpartners Workers Compensation network and panel providers. This includes implementing strategic plans developed by Work Partners management team to support new business growth as well as enhancement of all existing business lines. The Network Manager's responsibilities will include coordinating all aspects of network expansion including identification and recruitment of ancillary services and performing ongoing network analysis.

Responsibilities:

• Work collaboratively with network management, provider relations, IT, legal and other internal health plan departments regarding procedural, operational, credentialing and contractual processes.
• Educate the claims staff(s) with regards to network capabilities Manage the maintenance and administration of network databases including contract repository and linkage to panel tool.
• Monitor and manage medical cost containment vendor performance.
• Identify potential network provider leads, develop recruitment and training materials, and educate providers on panel and network expectations.
• Analyze and execute network expansion opportunities commensurate with workers compensation expansion plan beyond the state of Pennsylvania.
• Responsible for the network development within the state of Pennsylvania with additional targeted focus on central and eastern Pennsylvania.
• Collaborate with panel team to bridge provider network gaps and needs.
• Ensure timely execution and quality of network contracts.
• Develop, prepare, evaluate and present reports regarding network performance.
• Investigate sales/marketing requests concerning the recruitment of physician, ancillary and facility providers.
• Serve as the main point of contact for provider issues or questions.
• Manage vendor repricing as they would apply to contracted tier network discounts.
• Coordinate as appropriate with network vendors the resolution of repricing/payer disputes.