Network Manager - Erie (Hybrid

UPMC Community Care Behavioral Health is hiring a Network Manager to join the Erie Network Management team. This role will work in a hybrid structure with 3 days in the office each week. Occasional travel may be required for site visits or off-site meetings, however, this will be limited.

The Network Manager leads a team of professionals to work in collaboration with network providers to ensure delivery of high quality, cost efficient behavioral healthcare services to mutual customers of Community Care. Establishes goals for the department that lead to not only the department's success, but also the overall success of Community Care. Interacts with other internal and external customers to set appropriate goals and establish priorities for the Network Management staff. Prepares and organizes deliverables required for the assigned network(s.

Responsibilities:

• In collaboration with Senior Director Network and Regional Director, recruit, train, supervise and evaluate staff assigned to contract.
• Conduct Individual Provider Orientation/Service meetings to review Authorization procedures, billing requirements as well as a review of Member rights/responsibilities.
• Investigate Licensing Regulations and/or HealthChoices Regulations when presented with provider specific questions.
• Prepare all network agenda items for clinical-operations meetings and follow through with any required action items.
• Serve as the point person for all provider related inquiries (with the exception of direct claims related questions. This includes, but is not limited to, issues related to the following: Credentialing network expansion fee schedules regulations, Allowable billing activities, PROMISe related matters
• Prepare all contract related network deliverables, including but not limited to Geo-Access reports and waivers, RAI/PEPS information and any on-going monitoring of network activity.
• Oversee all network expansion activities for new and existing providers including the following: Developing financial impact analysis Obtaining verification of specialization Reviewing information at Clinical Operations Meeting Reviewing credentialing information Submitting Supplemental Service Enrollment Applications to the State on behalf of the Provider Assist Providers in Service Description Development
• Coordinate problem resolution for providers as necessary and ensure ongoing collaboration with providers to support Community Care initiatives.
• Collaborate consistently with Regional Director to prepare for and present network updates at OMHSAS monitoring meetings.
• Develop written communication following provider meetings in which quality of care concerns are discussed.
• Participate in meetings with the County Administration (and/or HealthChoices oversights who are the direct contract holders for the Medicaid contract with the state.
• Ensure ongoing provider communication through the facilitation of Provider Advisory Committee Meetings (including responsibility for the following: creating agenda, presenting information, leading discussion to large groups of providers in the respective contracts.
• Participate and prepare materials for Office of Mental Health and Substance Abuse (OMHSAS Monitoring Meetings
• Oversee daily activities of staff to ensure compliance with workflows and timeframes
• Bachelor's Degree in business, health care, management, or a related field is required.
• 3 years of business/sales or healthcare related experience required.
• Prior behavioral health experience is strongly preferred.
• Ability to forge strong interpersonal relationships within the department, other departments, and with the physician network.
• Strong leadership, planning, communication, documentation, organizational, analytical, and problem solving abilities.
• Ability to interpret and summarize results of various analyses in a timely manner.
• Ability to re-engineer processes to positively impact the performance of the department and Community Care, as well as individual provider offices.
• Ability to analyze financial and clinical results and to comprehend forecasting models.

Licensure, Certifications, and Clearances:

• Act 34 with renewal

UPMC is an Equal Opportunity Employer/Disability/Veteran