Responsible for the development and maintenance of the Network Plan the provider handbook, for evaluation of the adequacy of the network, for assuring that the network meets URAC and DoD standards, and that there is compliance with all elements of the TRICARE Management Activity contract. Understands the attitudes and values of the community and establishes effective working relationships with stakeholders to increase resources and collaboration. Acts as a representative and spokesperson for US Family Health Plan both internally and externally. Responsible for assuring providers and network members are educated in Health Plan criteria and processes. Responsible for the non-clinical utilization management functions of the Health Plan. Responsible for compliance with the DoD contract regarding network and utilization issues. Responsible for a key role in provider contracting and network relations.
Leads contract negotiations for acceptable reimbursement terms and contract language with all network providers across the continuum of care. (i.e. hospitals, physician groups and ancillary services). Will conduct negotiations and complete the contracting process in a timely manner in accordance with USFHP contracting principles, organizational policies and procedures and all elements of the TRICARE Management Activity contract.
Providence caregivers are not simply valued - they're invaluable. Join our team at Pacmed Clinics DBA Pacific Medical Centers and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.
Required qualifications:
Preferred qualifications:
Why Join Providence?
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our mission to advocate, educate and provide extraordinary care.
At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.
Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate''s placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.
Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.