Job Details

Our Company

Abilis Health Plan

Overview

The Provider Network Manager is responsible for maintenance and management of an adequate provider network by fostering relationships with providers.

Responsibilities

• Identify and participate in process improvement initiatives that improve the customer experience, enhance workflow, and/or improve the work environment
• Monitoring of various reports and collaborating with leadership to ensure all requirements are met and maintained
• Management duties including, but not limited to, hiring, training, and developing, coaching and counseling, and terminating department staff, as deemed necessary
• Reporting to leadership current status, risks, and potential opportunities in area of responsibility
• Maintaining and analyzing network adequacy to quickly identity service gaps
• Ensures provider data base is accurate and up to date
• Oversees provider contracts by ensuring all credentialing documentation is received, documented, and stored per CMS requirements
• Evaluates and monitors contract performance to determine necessity of amendments or extensions of contracts
• Analyzes service agreements, financial reports, and other data to determine reasonableness of contracts
• Collaborating with Sales, Account Managers, and Credentialing to solve provider issues
• Participate in process improvement initiatives that improve the customer experience, enhance workflow, and/or improve the work environment
• Identifying contracting needs and collaborating with team to secure and negotiate needed contracts
• Assisting with negotiating and renegotiating contracts with physicians and provider groups as assigned
• Responsible for working and resolving provider disputes as necessary

Qualifications

• Bachelor's Degree in business or health related discipline such as Healthcare Administration or Healthcare Management
• Two to three years Medicaid and/or Medicare experience preferred
• Provider servicing experience
• Knowledge in provider data base management
• Excellent verbal and written English communication skills
• Demonstrated intermediate to advanced skills in Microsoft Word, Excel, Power Point and Outlook, Internet and Intranet navigation
• Highest level of professionalism with the ability to maintain confidentiality
• Ability to communicate at all levels of organization and work well within a team environment in support of company objectives
• Customer service oriented with the ability to work well under pressure
• Strong attention to detail and accuracy, excellent organization skills with ability to prioritize, coordinate and simultaneously maintain multiple projects with high level of quality and productivity
• Strong analytical and problem-solving skills
• Ability to take initiative and make suggestions for improvements
• Ability to work with minimal supervision, take initiative and make independent decisions
• Ability to deal with new tasks without the benefit of written procedures
• Approachable flexible and adaptable to change
• Function independently, and have flexibility, personal integrity, and the ability to work effectively with stakeholders and vendors

About our Line of Business

Abilis Health Plan, an affiliate of BrightSpring Health Services, is a Medicare Advantage Plan covering all the benefits of Original Medicare (Parts A and B) with prescription drug coverage (Part D). The Abilis Health Plan is a unique plan allowing members to enroll year-round. The plan focuses on members who meet residential requirements in participating nursing facilities. An interdisciplinary team of clinicians and innovative services allow us to meet each member's clinical needs and provide preventive, coordinated, and quality healthcare. With a dedicated nurse practitioner leading a personalized care plan, we strive to improve the health of the communities in which we serve. For more information, please visit www.abilishealth.com. Follow us on LinkedIn.