Network Manager - CCBH

Description

UPMC has an exciting opportunity for a Network Manager within Community Care Behavioral Health (CCBH)! This is a regular, full time position with hybrid work arrangements. The Network Manager - CCBH will work remotely, save for occasional quarterly in-person meetings or trainings.

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 the Director of Provider Relations to 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:Credentialingnetwork expansionfee schedulesregulationsAllowable billing activitiesPROMISe 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

Qualifications

• Bachelor's Degree in business, health care, management, or a related field is required. Master's Degree preferred.
• 5 years experience in health care insurance or health care industry required.
• 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:

UPMC is an Equal Opportunity Employer/Disability/Veteran

Salary : $27 - $46