Meridian · 2 days ago
Manager, Provider Network Operations
United States
Full-time
Remote
Mid, Senior Level
$88K/yr - $158K/yr
5+ years expCentene is transforming the health of our communities, one person at a time. The Manager Provider Network Operations supports all provider network operational activities and ensures compliance with standards for network participation and regulatory requirements, managing various operational functions and driving process improvements.
Health Care
Responsibilities
Monitors all provider network operational functional areas to ensure production is compliant with all internal standards and develops corrective actions plans as needed to address non-compliance
Monitors department’s compliance with internal and external corrective actions plans
Manages the Provider Network Management dashboard which measures compliance with internal production and department standards
Takes a lead role in the implementation of new initiatives
Provides ongoing national/regional process improvement/standardization processes and leverages resources across health plans
Manages department operations in compliance with Health Net, state and federal regulatory requirements and accrediting entity standards
Interprets and coordinates work functions, and establishes standards of performance in order to carry out policy
Oversees, develops, manages, and coordinates database/system
Oversees compliance, oversight and reporting of monthly departmental key indicators
Data Management, Provider Network Management, Contracting, Sales, Quality Improvement, Appeals & Grievances and Compliance
Participates in National Credentialing Advisory Committee, regional Delegation Oversight Committee, Peer Review Committee, Health Net Quality Improvement Committee, and other national/regional steering committees
Maintains ongoing internal and external communication with subordinates, providers, groups, regulatory bodies and corporate
Coaches and/or staffs on all internal operations including credentialing, contract administration, corporate policy, national accreditation standards
Responsible for Associate Survey results and development of staff, including training and coaching
Oversees document submission/review for internal/external requests by legal counsel, regulatory bodies and internal fraud and abuse investigators
Manages and directs industry collaboration effort (“ICE”) process improvement activities that support collaborative efforts across health plans and medical groups/entities
Qualification
Required
Minimum five years management or supervisory experience in a progressive leadership role
Candidates must be in the state of Michigan to be considered for this role
Preferred
Bachelor's Degree in Health Care Administration, Business or related field
Benefits
Health insurance
401K
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Company
Meridian
Meridian in Michigan’s (Meridian) mission is to continuously improve the quality of care in a low-resource environment.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
unknown2018-05-29Acquired
Leadership Team
Nick Rotondo
Chief Financial Officer
Jovan Jamison
Community Health Worker | Case Manager | Medicaid Advisor | Community Partner | Client Advocate
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