• Fountain Valley, CA
  • Miscellaneous
  • Full-Time
  • 17390 San Mateo St

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The Director of Provider Network Management & Member Servicesis responsible for executing revenue-driven initiatives in a highly competitive marketplace by developing and implementing effective Provider Network, Provider Relations and Member Service strategies. Ensures thoughtful and tactical network development, physician recruitment and provider maintenance to attract and retain members.

Responsible for maintaining and nurturing effective relationships with providers, health plans, hospitals and local community resources. Collaborates and markets networks with brokers and health plan career agents to increase membership across targeted product lines. Identifies and seizes new business opportunities to ensure achievement of revenue-driven objectives. Principal Duties andResponsibilities:
  • Responsible formonitoring network adequacy, and in partnership with the Director ofContracting, alignment of necessary specialties to ensure access to necessarymedical specialties including tertiary services.
  • Keeps informed onnew provider compensation strategies or methodologies such as capitation,bundled payments, and pay for performance opportunities or other means ofcompensation incentives to engage providers with Seaside strategies.
  • Responsible formonitoring and oversight of provider data integrity in accordance with SB 137.
  • Organizesand/or conducts effective Joint Operation Committee meetings and/or managementreview sessions with designated providers and/or groups to further Seasidesgoals.
  • Responsiblefor effectively managing an operating budget, quality benchmarks and establishingmembership targets and increasing membership though retention or new members.
  • Providesleadership and direction; develops metrics and tools to measure/effect progresson team goals: increase revenue and reduce unnecessary expenses.
  • Provides guidanceto Managers with interviewing, hiring, performance evaluations, training, staffdevelopment, employee engagement and issue resolution.
  • Providesemployees with opportunities for professional growth and development throughongoing performance feedback and performance appraisals; coaching for success;removing barriers for achievement of goals, communicating a clear vision andinfluencing and motivating employees to achieve business results.
  • Responsiblefor ensuring compliance with company and regulatory requirements.
  • Focuseson process improvement and strategies to increase effectiveness including LEANinitiatives, utilizing technology, people and standard work.
  • Fostersa positive corporate culture by promoting and demonstrating the company'svision and values.
  • Collaborate withmanagement and staff from other departments to develop standard processes,resolve issues and further the business goals of the company.
  • Qualifications

  • Minimum of 5 years experience in management role(s).
  • 5 years of experience in the healthcare industry, preferably with directphysician interaction
  • Strongcomputer skills, Word, Excel, Access, PowerPoint, and office equipment

  • Education:
    Bachelor degree in Business Administration, Health Care Administration or related field. Masters degree preferred

    * The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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