Alta Hospitals
Provider Network Manager- San Diego
Alta Hospitals, Orange, California, United States, 92613
The Network manager will manage assigned territory at a level to meet company objectives. Duties and responsibilities will include develop and maintain relationships with assigned physicians, oversee the compliance with identified revenue driven initiatives, and identify, pursue and grow new membership and business opportunities.
With approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services. Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. For 25+ years, Prospect Medical has been focused on our mission of supporting independent physicians where, through risk arrangements, we work closely together with health plans, facilities and healthcare physicians for the benefit of every person who comes to us for care. We provide quality healthcare services that are designed to offer our patients highly coordinated, personalized care and that help them live healthier lives. Prospect Medical Systems manages highly successful IPAs by leveraging our best-practices, results-driven administrative services to manage patients under risk arrangements with health plans/CMS.
Conduct routine visits to all providers as outlined in department policies to ensure performance compliance with revenue driven initiatives and focus on goals Identify opportunities to achieve membership growth by developing and capitalizing on relationships with physicians and pursuing business opportunities to support companywide revenue goals Maintain positive business relationships to ensure retention of existing providers, therefore, decreasing the potential membership loss due to provider terminations Oversee the compliance and participation of network physicians to ensure providers are responding timely and accurately to global requests made by any and all departments within our organization Comply with production reporting requirements as stated in Department Policies and Procedures by required time frame. Work well and develop relationships with Provider Relations Support Staff and other departments to effectively resolve issues that require root cause resolution from individuals within Prospect Medical. Supervise, train and mentor new Network Managers to meet department and company objectives
Minimum Education:
High School graduate or equivalent. Four (4) year college degree preferred. Minimum Experience:
Minimum of three (3) years of HMO/IPA experience in Provider Contracting. Previous supervisory experience preferred. Req. Certification/Licensure:
None. "Location-Based Pay Adjustment"
Conduct routine visits to all providers as outlined in department policies to ensure performance compliance with revenue driven initiatives and focus on goals Identify opportunities to achieve membership growth by developing and capitalizing on relationships with physicians and pursuing business opportunities to support companywide revenue goals Maintain positive business relationships to ensure retention of existing providers, therefore, decreasing the potential membership loss due to provider terminations Oversee the compliance and participation of network physicians to ensure providers are responding timely and accurately to global requests made by any and all departments within our organization Comply with production reporting requirements as stated in Department Policies and Procedures by required time frame. Work well and develop relationships with Provider Relations Support Staff and other departments to effectively resolve issues that require root cause resolution from individuals within Prospect Medical. Supervise, train and mentor new Network Managers to meet department and company objectives
Minimum Education:
High School graduate or equivalent. Four (4) year college degree preferred. Minimum Experience:
Minimum of three (3) years of HMO/IPA experience in Provider Contracting. Previous supervisory experience preferred. Req. Certification/Licensure:
None. "Location-Based Pay Adjustment"