Supervisor, Network Management

Summary

Reporting to the Manager, PNO, the Supervisor, Network Management oversees the daily operations of the Network Management team, ensuring maintenance of the IPA provider network directory. This role is also responsible for acting as a timely and professional liaison to the provider community and Health Plans, and handling complex provider and Health Plan inquiries. The Supervisor, Network Management also leads the team of In-House IPA Representatives, to develop and maintain positive professional relationships with client IPA provider offices.

Duties and Responsibilities:

• Organize, supervise, coach, train, and support assigned staff in day-to-day duties
• Responsible for the quality of PNO processes that interface with IPA clients and affiliated Health Plans
• Assists with the development of policies, procedures, and analysis of regulatory/program requirements to assess impact to MPM network relations and client operations
• Investigate, respond, and resolve Provider/Health Plan concerns regarding provider demographic data and network status
• Establish, maintain, and foster collaborative relationships through both verbal and written communication
• Collaborates with the PNO Manager on the creation of written communications to the MPM provider network
• Conducts existing Network Management Team business process audits to find opportunities for strategic improvements and perform regular quality assurance checks of sub-group operations
• Develops and maintains processes that provide timely notification within and external to the supervisor’s direct reports
• Monitors PNO Phone Queue’s operational needs, including ratio establishment, coverage schedule, and training, etc.
• Regular communication with Manager about key projects, goals, and challenges, escalating issues/barriers when they arise
• Proactively develop positive working relationships with other MPM departments and staff to resolve provider issues
• Attend provider and health plan meetings, as needed
• Ensure HIPAA compliance is always observed/performed
• Special projects, as needed

Minimum Job Requirements:

• Bachelor’s Degree in Business, Healthcare Management or related field
• 5+ years of Managed Care or Healthcare experience
• 2+ years of supervisory experience, preferably in a managed care setting
• EZ-CAP knowledge and experience required
• Proficiency in Microsoft Office Suite (Access, Word, Excel, PowerPoint, Outlook)
• Substantive knowledge of basic Internet terminology and functionality
• Familiarity with providers in Los Angeles County and MSO way of doing business

Knowledge, Skills and Abilities Required:

• Bachelor’s Degree in Business, Healthcare Management or related field
• 5+ years of Managed Care or Healthcare experience
• 2+ years of supervisory experience, preferably in a managed care setting
• EZ-CAP knowledge and experience required
• Proficiency in Microsoft Office Suite (Access, Word, Excel, PowerPoint, Outlook)
• Substantive knowledge of basic Internet terminology and functionality
• Familiarity with providers in Los Angeles County and MSO way of doing business