Network Management Specialist - SCMG Provider Services - Sharp Corporate - Day Shift - Full Time

Sharp HealthCare•San Diego, CA

10d•$34 - $49

About The Position

Professionally manages all aspects of an assigned SCMG provider region. Works closely with the physician network, affiliated hospitals, ancillary providers, Sharp HealthCare and all departments within SCMG. Specifically, recruit, orient and provide ongoing service to providers and ensure provider adherence to policies and procedures of SCMG and affiliated health plans. Identifies and resolves providers issues or concerns in a timely manner. Consistently supports SCMG by maintaining a positive and professional image.

Requirements

Associate's degree related field (equivalent from two-year college or technical school may substitute)
5 years IPA or related experience with excellent organizational, oral/written communication skills, and interpersonal skills.
Ability to read and analyze, and interpret contracts, general business periodicals, professional journals, technical procedures, or governmental regulations.
Ability to understand computer hardware and software applications.
Ability to write reports, business correspondence, and procedure manuals.
Ability to effectively present information and respond to questions from groups of managers, providers and the general public.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
Able to demonstrate specific technical knowledge related to LAN/WAN configurations and multiple practice management systems.
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Must be proficient in Microsoft Office and Internet technologies.
Must also be detail-oriented and be able to speak in front of large groups, audience can range from 1 to 150 individuals.

Responsibilities

Actively promotes improved relationships
Responsible for maintaining and enhancing relationships with Providers (including ancillary) and office staff.
Assist with development of marketing and public relations materials as requested for SCMG and its providers, affiliated health plans, hospitals, or consulting groups, such as newsletters or photographs of physicians
Develop relationships with community businesses (i.e. Senior Centers, Assisted Living Homes, Marketing Consulting Groups, etc.) and coordinate lectures, screenings, and other marketing events with that business
Oversees activities and coordinates projects with other persons within the Network Management Department to provide education and communicate information to the provider network. (i.e. Regional Council Meetings, PCP council, Office Manager Meetings, Joint Operation Committee Meetings, etc.).
Participate in health fairs, lectures, community events, and other marketing events to promote IPA and it's affiliated providers.
Responsible for producing, updating, and distributing information to provider network, including patient satisfaction reports, Pay for Performance initiatives and QISR.
Perform other functions as requested.
Coordinate and provide assistance to health plans and other clients as necessary for health education services (i.e. participate in health fairs and member orientations as needed).
Supports physicians and staff when implementing Information Technology in the provider offices. Able to demonstrate knowledge of hardware specifications and software applications. Installs, trains and maintains necessary applications in provider offices. Acts as liaison between Sharp IS and provider office.
Attend meetings as needed to provide information about IPA's policies & procedures and operations or as a departmental representative. Responsible for agenda preparation and content; records meeting minutes.
Ability to review, negotiate and comprehend physician contracts in order to respond to inquires from physicians & staff. Conducts contract analysis related to contract performance by examining appropriate claims and other applicable data.
Act as a liaison to ensure timely problem/issue resolution between Health Plans, Hospitals, SCMG, and Providers. Accountable as a liaison between providers and SCMG departments for successful identification and resolution of issues.
Identify and participate in educational classes that will improve the relationship between SCMG and physician network.
Coordinate the production and dissemination of necessary reports and surveys to effectively manage assigned region.
Responsible for conducting on and off-site training sessions for new and existing Providers and office staff. This includes but is not limited to education regarding contract interpretation, claims, coding, operations, reimbursement, compliance issues, clinical operations, policy and procedures, governmental regulation and technology solutions, i.e., HIPPA, AB1455 and Pay for Performance.