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St. Joseph Health / Covenant Health Provider Network Manager - Admin Affiliate Physicians in Hesperia, California

We are looking for a Provider Network Manager for the Admin Affiliate Physicians Department at Heritage Healthcare.

Location: Hesperia, CA

Work Schedule: Full time - 80 Biweekly Hours

Shift: 8-hour, Days

Apply Today! Applicants that meet qualifications will receive a text with some additional questions from our Modern Hire system.

Job Summary:

Under the supervision of the Chief Affiliate OPS/PHN COO, responsible for the growth and profitable development of the provider network in assigned area(s), and is the direct interface among Providence St. Joseph Health and the High Performing Network (HPN). Promotes population health initiatives aimed at improving the patient experience and health outcomes. This position provides continuous education, support, training and troubleshooting to affiliate physicians and their staff. Also serves as an interface between the Management Services Organization (MSO) and the HPN.

Essential Functions:

  • Growth

  • Works collaboratively with offices, PSJH marketing team and brokers to drive membership growth and retention.

  • Monitors and identifies trends on membership decline and escalates to leadership as appropriate.

  • Addresses primary care and specialist network specific issues identified as part of dis-enrolled member calls.

  • Assists with Medicare Annual Enrollment Period (AEP) efforts by working with offices, marketing team, and brokers; attends AEP events with marketing to strengthen relationships with PCPs.

  • Service

  • Serves as single-point-of-contact to the physician network and is accountable and responsive to physician needs.

  • Responds timely and appropriately to provider issues, works with other groups/central departments to resolve issues and updates providers and office staff regularly through to resolution.

  • Is proactive in identifying issues and determining root cause so that they can be resolved timely and completely. Escalates certain issues as appropriate to leadership.

  • Build collaborative relationships with Network physicians and their office staff.

  • Collaborates with hospital ministries to achieve strategic objectives

  • Manage a scheduled cadence for touch points and ensures that agreed upon agenda is followed and action items are documented and tracked.

  • Visibility

  • Attends external office staff meetings and community/town hall meetings, as required, and completes any action items that may arise from those meetings.

  • Maintains awareness of providers interested in further aligning with PSJH on new business opportunities, and on shifting market/competitive dynamics that would impact the Network.

  • Regularly educates offices on their current performance on key performance indicators (KPIs).

  • Quality

  • Monitors performance of assigned PCPs on a scorecard, identifies low performing PCPs and works with Network leadership to develop action plan for specific metrics needing improvement. Works with office to deploy action plan and monitors progress. Intervenes and escalate issues as appropriate.

  • Engages, seeks assistance from Network Medical Director and/or Quality Manager.

  • Supports and helps practices to earn the maximum bonus possible related to Clinical Quality and Patient Satisfaction measures.

  • Engages Network physicians and staff in promoting appropriate clinical pathways.

  • Expected to travel to physician offices or other facilities as needed.

  • Performs other duties as assigned.

Skills:

  • Must be knowledgeable about incentive programs, contract reimbursement, practice and network profitability, ACOs and other HCP initiatives, as applicable.

  • Must be knowledgeable about the various quality measures and improvement programs, and educates the offices on how to improve performance.

  • Demonstrated accountability for assigned network of physicians and practices required.

  • Demonstrated ability in leading and developing high performing teams required.

  • Ability to work effectively with all levels of personnel (e.g., MD, office staff) required.

  • Must possess excellent communication and interpersonal skills, with the ability to be personable yet persistent.

  • Must be a team player with strong listening skills.

  • Must take initiative and be proactive.

  • Must be detail-oriented with strong problem solving skills.

  • Robust analytical skills with an emphasis on data-supported decision making required.

  • Good understanding of HMO systems' provider reimbursement mechanisms required.

  • Knowledge of CPT-4 and ICD-10 coding systems required.

  • Excellent computer skills including customer relationship management tools (CRM) required.

  • Expertise in Microsoft Office applications (Word, Excel, PowerPoint) required.

  • Ability to travel based on business needs required.

Minimum Position Requirements:

Education: Bachelor's Degree

Experience: 3 years general healthcare, administrative support, project management or provider services work experience

Preferred Position Qualifications:

Education: Master's Degree in Healthcare Administration (MHA), Business Administration (MBA) or related area

Experience:

  • 5 years work experience in a health plan, managed care organization, medical group, physician office or network setting

  • Operations work experience with a track record of driving business and financial performance (profit/loss)

  • Leadership position experience in network development, business development and provider relations.

Mission Heritage Medical Group is one of California's most respected medical groups. With over 3,000 employees and 75 locations throughout California, including, Northern California, Orange County, High Desert and Los Angeles County, Mission Heritage Medical Group has been continually recognized as a leader in quality, customer service and information technology. This kind of success is the result of team work, a commitment to excellence and a strong adherence to the organization's mission, vision and values. Mission Heritage Medical Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Mission Heritage Medical Group complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Company: Heritage Healthcare

Category: Non- Clinical Lead/ Supervisor/ Manager

Req ID: R334762

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