Company:
Sonrava Health
Location: Orange
Closing Date: 17/10/2024
Hours: Full Time
Type: Permanent
Job Requirements / Description
Overview:
The Provider Network Manager will be responsible for assigned local (Los Angeles or Sacramento County) and out of state dental plan processes and activities necessary to develop and maintain the provider network and financing system. Responsible for project management, metrics and internal communication to Operation departments. Team lead and subject matter expert.
Responsibilities:
Job Responsibilities / Duties
Develop and maintain a competitive network of providers
Meet Health Care cost outlined for targeted assigned territories
Support marketing, sales and client activities as needed
Ensure network providers understand and adhere to company goals and initiatives set forth in the Policies and Procedures
Ensure network providers and staff understand DHMC regulations and guidelines
Support the Quality Management Program by monitoring provider compliance and quality.
Projects deadlines and success ratio met
Provider Relations staff quarterly recruitment goals are efficiently monitored and evaluated.
Effective teamwork and collaboration
Communications with all Operational Departments are effective and goals are met.
Developing and maintaining the provider network
Train provider network staff in OSHA compliance and assist in correcting deficiencies
Contracting providers within the targeted reimbursement levels
Responsible for successfully negotiating lower provider compensations models to meet targeted PMPM levels.
Manage assigned projects to a success conclusion
Analyze annual goals and team’s ability to meet goals and deadlines on a quarterly basis
Work closely with internal departments to identify the need for Provider Relations temporary and permanent intervention.
Responsible for Provider Relations Policies and Procedures
Responsible for Department Metrics
Provide subject matter expertise and advise as requested
Qualifications:
Bachelors degree, or (5) years minimum relevant experience as Dental Office Manager
Strong negotiation and reasoning skills
Thorough knowledge of managed dental care:Reimbursement mechanisms
Quality improvement initiatives
Ability to create and present solutions to specific problems
Thorough knowledge of government agency fee for services and managed care dental plans.
Ability to manage multiple projectsMeet goals
Meet timelines
Ability to conduct trainings to small and large groups
Experience working with Account Executives and the ability to present products to Brokers in a formal and in-formal environment
Travel 70-80%
CADP Auditor preferred
The Provider Network Manager will be responsible for assigned local (Los Angeles or Sacramento County) and out of state dental plan processes and activities necessary to develop and maintain the provider network and financing system. Responsible for project management, metrics and internal communication to Operation departments. Team lead and subject matter expert.
Responsibilities:
Job Responsibilities / Duties
Develop and maintain a competitive network of providers
Meet Health Care cost outlined for targeted assigned territories
Support marketing, sales and client activities as needed
Ensure network providers understand and adhere to company goals and initiatives set forth in the Policies and Procedures
Ensure network providers and staff understand DHMC regulations and guidelines
Support the Quality Management Program by monitoring provider compliance and quality.
Projects deadlines and success ratio met
Provider Relations staff quarterly recruitment goals are efficiently monitored and evaluated.
Effective teamwork and collaboration
Communications with all Operational Departments are effective and goals are met.
Developing and maintaining the provider network
Train provider network staff in OSHA compliance and assist in correcting deficiencies
Contracting providers within the targeted reimbursement levels
Responsible for successfully negotiating lower provider compensations models to meet targeted PMPM levels.
Manage assigned projects to a success conclusion
Analyze annual goals and team’s ability to meet goals and deadlines on a quarterly basis
Work closely with internal departments to identify the need for Provider Relations temporary and permanent intervention.
Responsible for Provider Relations Policies and Procedures
Responsible for Department Metrics
Provide subject matter expertise and advise as requested
Qualifications:
Bachelors degree, or (5) years minimum relevant experience as Dental Office Manager
Strong negotiation and reasoning skills
Thorough knowledge of managed dental care:Reimbursement mechanisms
Quality improvement initiatives
Ability to create and present solutions to specific problems
Thorough knowledge of government agency fee for services and managed care dental plans.
Ability to manage multiple projectsMeet goals
Meet timelines
Ability to conduct trainings to small and large groups
Experience working with Account Executives and the ability to present products to Brokers in a formal and in-formal environment
Travel 70-80%
CADP Auditor preferred
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