Network Management Specialist (Provider Data Validation)

Integrated Resources, Inc

San Diego, California

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JOB DETAILS

JOB TYPE

Contractor

SKILLS

Auditing, Behavioral Health, Clinical Research, Computer Skills, Contract Requirements, Data Entry, Data Quality, Healthcare Providers, Identify Issues, Information Technology & Information Systems, Information/Data Security (InfoSec), Leadership, Medical Treatment, Microsoft Access Database, Microsoft Excel, Microsoft Office, Microsoft Outlook, Microsoft PowerPoint, Microsoft Word, Needs Assessment, Network Administration/Management, Network Performance/Analysis, Problem Solving Skills, Project Planning, Provider Relations, Public Policy, Quality of Care, Regulatory Requirements, Rehabilitation Nursing, Service Delivery, Training/Teaching

LOCATION

San Diego, California

POSTED

1 day ago

Network Management Specialist (Provider Data Validation)Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.Job DescriptionTitle: Network Management Specialist (Provider Data Validation)Location: San Diego CADuration: 6+ months (possible extension)Responsibilities:This position is responsible for the support of all activities related to developing and maintaining the physician, practitioner, group, and/or facility, MPPS and organization services delivery system in small to mid-size market defined by membership, number of providers in delivery system, number of business operating units and lines of business.Interacts with all areas of organization to coordinate network management and network administration responsibilities.Assesses network needs, analyses network composition, and using organization databases application of regulatory requirements, accreditation entities and other resources, recruits individual, group and/or organizational providers to meet network adequacy standards and assure quality network.Conducts and coordinates contracting and amendment initiatives.Provides issue resolution and complex trouble shooting for providers.Conducts provider education and provider relation activities, providing necessary written materials.Conducts administrative provider site visits and coordinates report development and completion according to contractual requirements or ad hoc requests.Coordinates Public Policy Research Center (PPRC) activities to assure maintenance of current credentialing status, and evaluation and appropriate actions of quality of care issues and complaints against providers.Conducts and manages ongoing audits of provider compliance with policies and procedures as well as contractual obligations for multiple customers. Develops work plans to address audit requirements.Works with management to draft, clarify and recommend changes to policies which impact network management.Requirements / Certifications:Daily Responsibilities will include telephonic outreach to targeted providers to educate the providers on data validation regulatory requirements and to secure practice information.The expectation is to make 40 outbound calls per day, 5 per hour, averaging 12 minutes each.The goal is to reach 2600 Providers and validate by the end of Q2.This resource must be proficient logging information into an Excel spreadsheet, and using MS Outlook.Candidate will be required to perform subsequent data entry of the providers updated practice information into internal systems as needed, in addition to weekly reporting to CA leadership of telephonic outreach activities and compliance success.Bachelor degree required.Minimum of 1 year experience in behavioural healthcare related field.Computer Skills:Intermediate knowledge & experience with Microsoft Office Software including Excel, Project, Word, Access, and Power Point, and Outlook.Additional InformationKind RegardsSumit AgarwalBy clicking the link above or any third-party link within this posting, you are leaving this site and going to a third-party website where the third-party website's terms and privacy policy apply

Network Management Specialist (Provider Data Validation)

Integrated Resources, Inc

San Diego, California

About the Company

Integrated Resources, Inc

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