Sharp HealthCare · 5 hours ago
Lead Network Management and App Optimization - Sharp Health Plan Health Services - Day Shift - Full Time
San Diego, CA
Full-time
Onsite
Senior Level, Lead/Staff
$46.11/hr - $66.65/hr
5+ years expSharp HealthCare is a healthcare provider seeking a Lead Network Management and App Optimization professional. The role involves managing a team responsible for network compliance, provider data operations, and regulatory reporting, while overseeing project initiatives and ensuring data integrity.
Health CareNon Profit
Responsibilities
Leads a team of business analysts and coordinators to develop and maintain best-in-class and compliant provider data operations, including systems, applications, and reporting
Provides oversight to ensure delivery of accurate and timely data reporting for regulators, accreditors, key customers, and other internal and external stakeholders
Presents feedback to both team members and leadership to effectively manage both individual and team performance
Manages client and department expectations through effective client communication resolving conflicts and department issues independently through effective decisions
Proposes and implements creative solutions to operational and application issues with follow-through to resolution
Ensures provider data integrity by leading the team through efficient operational workflows and data cleaning cycles for data collection, standardization, normalization, de-duplication, and verification
Creates new and optimizes business process workflows for efficient and compliant provider data operations
Develops and maintains department standards for management of network functions, including development and maintenance of desktop procedures, quality assurance checklists, compliance checklists, and data monitoring tools
Builds network dashboards in Tableau for ongoing monitoring of provider data, provider network changes, network metrics, and network KPIs across the department
Trains new and existing analysts in system and operational tasks in order to maximize effectiveness and utilization of systems
Oversees end-user support by directly supervising the service-related activities for the team
Proactively identifies opportunities to translate and adopt best practices from within and outside of Sharp Health Plan to advance strategic and operational goals
Uses strong data analysis and research methodologies to assess effectiveness of innovative improvement efforts and works to implement validation approaches
Maintains regulatory and accreditation knowledge of Department of Managed Health Care (DMHC), Centers for Medicare and Medicaid Services (CMS), Covered CA, National Committee for Quality Assurance, and Health Insurance Portability and Accountability Act (HIPAA) requirements
Stays abreast of changing regulatory and customer requirements to ensure network compliance
Manages regulatory program for annual and ad hoc network filings for regulators and key customers
Produces business requirements and oversight of the production of network data forms and automated templates for regulatory filings and regulatory comment responses (TAR, Significant Network Change, Alternate Access, Medicare HPMS, Ad Hoc filings)
Leads and oversees enhancements and upgrades to systems and provider applications to accommodate new regulatory requirements
Develops and maintain protocols, training, and oversight to ensure delivery of timely and accurate regulatory filings, data exchanges, and reports
Leads team in maintaining up-to-date production plans, project plans, schedules and dashboards for regulated deliverables (filings and regulatory reporting, geoaccess and adequacy monitoring, online and print provider directories, et al)
Oversight, monitoring and quality assurance for annual reporting to Compliance for filing deliverables, e.g., network filings for DMHC, CMS, Covered CA, alternate access standards, provider directories, and other Compliance reporting, as needed
Analyzes department and client needs to develop a workable training plan and executes training plan appropriately
Identifies and trains super users and other staff in operational and system tasks to ensure regulatory compliance and maximize effectiveness and utilization of applicable systems
Ensures team members consistently provide audit support for DMHC, CMS and NCQA through creation, maintenance and appropriate storage of regulatory project, business rule and business process documentation in a timely, clear, and accurate manner
Creates and maintains a matrix of all assigned projects using appropriate prioritization, timing, and creativity, such that projects are completed on time and within resource constraints
Oversight of communication plans, strategies and documents to keep clients informed with major initiatives or system related issues
Communicates in a timely fashion both to the requestor and management when project schedules may not be met
Provides executable alternative solutions to work around resource constraints
Develops comprehensive project plan and oversees individual project plans based on accurate project scope, project risk, detailed business requirements, resource allocation and scheduling requirements
Oversees risk identification and management plans
Provides oversight of team reporting for all assigned projects
Ensures close collaboration with internal and external technical, information systems, Compliance, and outside vendors
Develops department standards for management of changes and documentation requirements
Creates department standards for service level agreements (SLAs) to clients on submitted requests
Provides oversight for department change management requests and assigns resources as needed
Evaluates and oversees department documentation for system recovery
Reviews and approves changes to production environments as part of system implementations for various systems, including but not limited to, Epic, MD-Staff, Health Trio online provider directory, Tableau, Looker, SSRS, SQL/Snowflake environments, CMS's Medicare Plan Finder, Symphony (statewide DMHC attestation portal, and Sitefinity (web content management system)
Implements new applications and upgrades existing applications, as needed, i.e., Epic, MD-Staff, Symphony, Quest Analytics, and RightFax
Provides leadership with the necessary information to review current and new technologies for incorporation with existing technologies within the department
Acts as in-house consultant to internal and external IT application teams in the evaluation of new technologies and/or data feeds
Represents the Network team in launching plan- and system-wide provider applications, system enhancements and upgrades
Represents the department on strategic initiatives to ensure that a thorough evaluation is performed on impacts to existing applications
Works with IT personnel, vendors and clients in reviewing requests for appropriateness within the Sharp computing environment
Establishes protocols for interoperability and quality assurance for provider data systems
Oversees risk identification and management plans
Analyzes department and client needs to develop a workable training plan for systems and applications used by Health Services teams and executes training plan appropriately
Oversees issue resolution to ensure that problems are resolved in a timely manner and the resolution is fully documented and meets customer and IT accepted frameworks
Participates in special projects and other duties as assigned. These may include, but are not limited to, committees, workgroups, proposals, audits and support to other departments
Qualification
Required
Bachelor's Degree Business administration, computer science, information science, management information systems, or healthcare related field
5 Years experience in business analysis, systems analysis/configuration, or process improvement
2 Years experience with software applications for healthcare functions, such as credentialing, provider management, claims processing, call center integration, utilization management, case management, medical review, pharmacy, quality and reporting
1 Year Experience in health plan accreditation and regulatory requirements, and/or regulatory filings for the DMHC, CMS and Covered CA
Strong working knowledge of health plan operations and business workflows
In-depth knowledge of systems analysis, design and support of applications in a large computing environment comparable to Sharp Health Plan and Sharp HealthCare
Ability to oversee the design, development, and implementation of software solutions, systems, or products that meet end-user needs; excellent analysis, problem-solving, and troubleshooting skills; and the ability to manage various user requests from internal and external stakeholders
Ability to communicate concepts and solutions in both technical and user-friendly language. Strong ability to translate technical requirements into business language and business requirements
Excellent team management skills, with proven ability to train, coach and motivate
Strong knowledge of health plan regulatory requirements, including federal and state regulations (HIPAA, DMHC, CMS, Covered CA) and NCQA accreditation requirements
Excellent project management skills, with proven expertise in leading and overseeing project teams
Excellent written and oral communication skills. Excellent listening and interpersonal skills. Ability to conduct research into systems issues and products as required
Highly self-motivated and directed
Preferred
Master's Degree Business administration, computer science, information science, management information systems, or healthcare related field
Leadership experience
Company
Sharp HealthCare
Sharp HealthCare is a not-for-profit integrated regional health care delivery system based in San Diego, Calif.
10001+ employees
H1B Sponsorship
Sharp HealthCare has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (2)
2024 (3)
2023 (3)
2021 (1)
2020 (3)
Funding
Current Stage
Late StageTotal Funding
unknownKey Investors
Parkinson's Foundation
2023-07-25Grant
Leadership Team
Dan Exley
Vice President of Clinical Systems
Recent News
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2025-12-27
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