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Manager, Provider Network Management

Santa Clara Family Health Plan San Jose Full-Time
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Consider a career at Santa Clara Family Health Plan (SCFPH), a public, not-for-profit plan of over 250,000 members serving Santa Clara County.

GENERAL DESCRIPTION OF POSITION

The Manager, Provider Network Management is responsible for providing day-to-day management and leadership of the Provider Network Management team involved in provider relations and SCFHP’s access/availability program. This includes the development and execution of all strategies related to outreach, training, education, and service to the SCFHP provider network. The Manager designs and implements programs to build and nurture positive relationships between SCFHP, providers (health plans, physicians, hospitals, ancillary, IPAs, etc.) and practice managers. Responsibilities include conducting initial and subsequent provider orientations, maintaining compliance with provider related SCFHP standards, local, state and federal regulations and accrediting agencies, troubleshooting provider concerns, conducting outreach related to provider disputes and claims issues, and implementing ongoing quality initiatives. The Manager works collaboratively with the Director, Provider Network Management, representing the department at management and cross-functional meetings and interfacing with other departments as necessary. 

FLSA Status: Exempt

Department: Provider Network Management

Reports To: Director, Provider Network Management

ESSENTIAL DUTIES AND RESPONSIBILITIES

To perform this job successfully, an individual must be able to perform each essential duty listed below satisfactorily.

1. Develop comprehensive training and resource materials related to SCFHP processes and procedures. This includes drafting and maintenance of the SCFHP Provider Manual, website and provider portal content, provider newsletters, bulletins and other planned and ad hoc provider communications.

2. Create effective strategies for conducting provider outreach to provide timely information to the SCFHP provider network and to receive timely feedback from the network. Assure timely and appropriate responses to inquiries from the provider network. 

3. Develop and conduct internal training across departments to assure appropriate knowledge and tools exist throughout the organization for servicing providers and understanding handoffs between departments. 

4. Develop and manage processes for measuring access and availability and physician satisfaction including developing and executing surveys, tools, and resources required by SCFHP policy and other state and federal regulations.

5. Represent the department at SCFHP committee meetings. Act as a subject matter expert for cross-functional activities. Be the voice of the provider community at SCFHP, communicating the needs of the provider network as they relate to administrative processes, policies and performance.

6. Manage the process for granting access to the SCFHP provider portal. 

7. Manage the Physician Advisory Council, developing relationships with participants, organizing meetings and agendas and keeping topics relevant and engaging.

8. Hire, manage and develop the provider network associate team to develop effective communication strategies, including timely, documented efforts related to education of new and existing providers.

9. Coordinate with the Manager, Provider Data and Reporting and the Manager, Contracting and Credentialing to create seamless hand offs related to onboarding, credentialing and recredentialing of providers and assuring accurate set up and configuration in SCFHP systems. 

SUPERVISORY/MANAGEMENT RESPONSBILITIES

Carries out supervisory/management responsibilities in accordance with the organization’s policies, procedures, applicable regulations and laws.  Responsibilities include:

1. Recruiting, interviewing, and hiring.

2. Developing a high performing department culture and staff.  This includes setting the standard for staff/peers and motivating employees to maximize organizational goals and objectives.

3. Effectively assimilating, training and mentoring staff and (when appropriate), cross training existing staff and initiating retraining.  This includes coaching to help increase skills, knowledge and (if applicable) improve performance.

4. Setting goals and planning, assigning, and directing work consistent with said goals.  This includes responding to employees’ needs, ensuring they have the necessary resources to do their work.

5. Appraising performance, rewarding and disciplining employees, addressing complaints and resolving issues.  This includes providing regular and effective feedback to employees and completing timely and objective performance reviews.

The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.

1. Bachelor’s Degree in Business, Healthcare Administration, or a related field, or equivalent experience, training or coursework. 

2. Minimum five years of health plan experience. Strong knowledge of managed care fundamentals, preferably with experience in government programs (i.e. MediCal, Medicare).  

3. Demonstrated achievement and progressive responsibilities in the area of provider network management. 

4. Minimum three years direct supervisory/management experience. 

5. Ability to consistently meet compliance accuracy and timeline requirements by achieving regulatory standards. 

6. Ability to organize, plan, direct and manage complex, cross-functional, multi-departmental projects and/or programs; able to manage multiple concurrent initiatives and effectively prioritize in a dynamic environment.

7. Excellent communication skills including the ability to represent the organization orally and in writing, and to present in group settings and at all levels of the organization. 

8. Strong writing skills and demonstrated proficiency in developing content related to provider manuals, training materials and web content. 

9. Strong understanding of NCQA, HEDIS and government requirements.  

10. Proficient in adapting to changing situations and efficiently alternating focus between tasks to support department operations as dictated by business needs. 

11. Working knowledge and the ability to efficiently operate all applicable computer software including applications such as Outlook, Word and Excel.  

12. Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position.  

13. Ability to maintain confidentiality.  

14. Ability to comply with all SCFHP policies and procedures.  

15. Ability to perform the job safely with respect to others, to property and to individual safety. 

16. Maintenance of a valid California driver’s license and acceptable driving record, in order to drive to and from off-site meetings or events, or the ability to use other means of transportation to attend off-site meetings or events. 

BENEFITS

Santa Clara Family Health Plan offers a comprehensive benefits package including PTO, holidays, fitness center membership, medical, dental and vision coverage, CalPERS retirement, 401 and 457 Deferred Compensation retirement plans.

CONTACTS

To view the full job description or to apply please visit our careers page at www.scfhp.com

                                                                EOE                                                                     

Skills required

Negotiation
Business Development
Value (Economy)
Consulting
Relationship Building
Presentations
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Since 1997, SCFHP has partnered with providers to deliver high-quality health care to our members. Through dedication to integrity, outstanding service, and care for our community, we work to ensure that everyone in our county can receive the care they need for themselves and for their families. We currently serve over 250,000 residents of Santa Clara County.

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