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Network Management Specialist

Company: SCAN Health Plan
Location: Long Beach
Posted on: September 13, 2020

Job Description:

As one of the nation’s largest not-for-profit Medicare Advantage plans, serving more than 200,000 members in California, SCAN Health Plan has been a mission-driven organization dedicated to keeping seniors healthy and independent for over 40 years. SCAN employees are passionate about what they do, and understand that success is based on achieving the mission. Employees are afforded with the training and tools necessary to do their jobs and are rewarded for their efforts and recognized as experts in their fields. To learn more, visit scanhealthplan.com or follow us on social media: LinkedIn ; Facebook ; and Twitter .

The job

To support the department objectives and provider networks through contract negotiations that are not only compliant and financially viable, but also aligned with company vision metrics. Build and maintain positive relationships with Providers in a designated geography (including Medical Groups, IPA’s Hospitals, Physicians, and Providers) while managing their service needs and adhering to regulatory requirements. Collaborate with internal SCAN departments to ensure quality and access to care for our members.

You will

Serves as SCAN's primary point of contact for assigned providers.

Enhances the effectiveness of assigned providers' programs by recommending process improvements, supporting the establishment of operational guidelines, and providing contract monitoring support and assistance as needed.

Enhances the relationship with assigned provider’s effectively responding to requests for information, monitoring and influencing provider performance, and successfully resolving issues related to capitation, claims, and other operational functions.

Assists with ongoing network and provider analysis by researching new areas for development and reviewing current service areas to determine need for additional providers. Creates presentations, drafts proposals and other business correspondence, and prepares reports to assist with network expansions.

Provides administrative support and coordination for all Supplemental, Ancillary, Group and Independent Living Power (ILP) contracts in order to increase program efficiencies. Performs a wide variety of tasks, including letter and form development, verbal and written correspondence flow charts, task tracking, research, data summary, etc.

Participates in the re-negotiation of contracts and drafts appropriate documentations.

Maintains on-going contract communications, internal and external, for all programs by establishing and completing data tracking and communication instruments in a timely and correct manner. Maintains the provider contracting, reporting and monitoring process (InteliContract, LSA, NCN, etc).

Coordinates SCAN regulatory and policy compliance and audit activities with assigned providers. Facilitates and monitors communications between SCN internal departments and providers, reviews audit results, tracks provider progress to compliance goals and recommends appropriate action for continued noncompliance.

Maintains internal SCAN awareness of network changes by issuing timely and accurate Provider Bulletin communications about contractual risk disposition changes, provider terminations and additions, and panel closures.

Supports efforts of Network Management by collaborating with external departments within SCAN, and participating in interdepartmental meetings and selected committees.

Participates in internal company initiatives/projects and/or process improvement endeavors.

Demonstrates knowledge of regulatory compliance issues as they relate to provider contracts. Successfully conveys the need for regulatory and contract changes to providers.

Ensures SCAN overall compliance by responding to grievances/appeals and adhering to regulatory and departmental Policy and Procedure guidelines and timeframes.

Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.

Contributes to team effort by accomplishing related results as needed.

Actively supports the achievement of SCAN’s Vision and Goals.

Your Qualifications

Bachelor's Degree in Business Administration or related field

2+ years of experience with provider service operations required.

Health care experience required.

Contract negotiation experience preferred.

Strong quantitative, written and oral communication skills including presentations, negotiations and interpersonal skills strongly preferred.

Strong multi-tasking and organizational skills with minimal supervision.

Ability to execute work under pressure and tight deadlines.

What's in it for you?

A competitive compensation and benefits program  An annual employee bonus program Robust Wellness Program Generous paid-time-off (PTO) Ten paid holidays per year Excellent 403(b) Retirement Saving Plan with employer match Business Casual attire Robust employee recognition program A work-life balance and much more! We're always looking for talented people to join our team. Qualified applicants are encouraged to apply now!

SCAN is an equal opportunity employer. All qualified applicants will receive consideration for employment.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)

Keywords: SCAN Health Plan, Long Beach , Network Management Specialist, Other , Long Beach, California

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