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Partners Health Management · 5 hours ago

Provider Network Development Manager-Data & Analytics

Gastonia, NC, US

Full-time

Hybrid

Senior Level

5+ years exp

Partners Health Management is a healthcare organization focused on improving network adequacy and performance. The Provider Network Development Manager – Data and Analytics is responsible for ensuring compliance with network adequacy standards, analyzing network performance, and collaborating with providers and stakeholders to enhance member access and quality in the provider network.

FitnessHealth CareMedical

Work & Life Balance

Responsibilities

Provides project management for the company’s strategic objectives, working with internal and external stakeholders to determine project definition and business requirements

Collaborates with other departments to deliver comprehensive and compelling recommendations for strategic initiatives for positive impact, including: Identify service gaps and needs and acts to develop solutions; Estimate cost(s) of gaps; Improve Population Health Outcomes through ensuring member access to services and that the network is available to serve members; Ensure service delivery is in accordance with best practice models and clinical coverage policies

Development of spectrum of value and performance based programs across lines of business in alignment with core population health strategic goals

Manages the Network Adequacy requirements as defined by the State and develops reporting on a regular basis, either monthly or quarterly

Develops reporting metrics and ensures timely submission of required state reporting while working collaboratively across the organization to identify development opportunities and illustrate network accessibility compliance

Manages and ensures compliance of the Network Access Plan as per State expectations

Collaborates with health plan regarding compliance with network adequacy for all network requirements through data review, monitoring and collaboration

Manages and/or leads the formation of requests for proposals and/or requests for information that directly support a robust provider network to ensure compliance with Network Adequacy Standards

Manages the exception reporting for the purposes of compliance with the DHHS contracts

Participates in input into the development of the member and provider portals for the purposes of ensuring network adequacy and communicates across departments to identify needs/gaps to improve the member/provider experience in the network

Manages and fosters solid collaborative relationships with external stakeholders and internal department leaders to develop innovative plans for special projects with detailed scopes of work and project management for next steps

Assesses and manages risk throughout all aspects of the solution design and development and escalates as needed. Monitors progress, reports results/outcomes and adjusts as needed

Partners with legal and regulatory teams to ensure all approvals/regulations obligations during the design phase have been met

Implement network engagement strategies linking strategic goals to the execution of network adequacy, network management, and the network access plan

Interprets audit results, identifies trends/patterns that impact service/system quality, and then implements interventions aimed at addressing these trends/patterns with the outcome of services delivery to members at the highest degree of quality cross functional team activities

Experience recruiting and procuring new business opportunities to further develop and support the members in the network and close identified care gaps

Ensures all policies/procedures, network access/development plans are developed and implemented according to regulatory guidelines and standards, including state, federal and external review bodies

Oversees the maintenance and updating of the Provider Operations Manual by collaborating with each provider network team and ensuring the state updates/corrections are included as needed

Manages performance and development specialists charged with implementation of value-based contracts, ensuring network adequacy, and collaborating with internal teams to develop provider quality and performance measures

Ensure needed data is collected on a timely basis and make recommendations for future improvements based on the data

Ensure the strategic goals of the organization are realized through the network development cross function team and report progress to PN Leadership and other audiences as indicated

Innovative in working collaboratively to identify opportunities for improvement in the lives of the members

Track and tend quality and financial goals to show performance rate

Demonstrated skills in oral and written communication

Qualification

Provider network managementData analysisProject managementHealthcare delivery experienceInterpersonal skillsMicrosoft Office proficiencyCommunication skillsProblem solvingNegotiation skillsConflict resolution

Required

Bachelor's degree in health care administration, business administration, accounting, finance, or human services

Five (5) years of experience in provider network management, health care insurance or other health care delivery setting

Three (3) years of supervisory, consultative or administrative experience

Ability to travel as needed to perform job duties

NC Residency is required

Considerable knowledge of the laws, regulations and policies that govern the program

Exceptional interpersonal and communication skills

Strong problem solving, negotiation, arbitration, and conflict resolution skills

Excellent computer skills and proficiency in Microsoft Office products (such as Word, Excel, Outlook, and PowerPoint)

Demonstrated ability to verify documents for accuracy and completeness; to understand and apply laws, rules and regulations to various situations; to apply regulations and policies for maintenance of consumer medical records, personnel records, and facility licensure requirements

Ability to make prompt independent decisions based upon relevant facts

Ability to establish rapport and maintain effective working relationships

Ability to act with tact and diplomacy in all situations

Ability to maintain strict confidentiality in all areas of work

Ability to prioritize work to meet deadlines

Ability to present complex data and information to varying audiences, both internal and external, in a professional and clear manner

Ability to apply appropriate judgment and discretion in interpreting and reporting of data

Strong project management skills

Ability to summarize analytical results graphically and numerically in Microsoft Excel, PowerPoint, and ability to utilize various software products

Preferred

Master's degree

Two (2) years' experience in physical or behavioral health network operations, network management, provider relations, health care managed care, and/or healthcare payor systems

Experience analyzing and assimilating provider performance and healthcare outcomes data

Knowledge of patient/member/provider portals, reporting systems, and/or other reporting/data programs