opportunities. n The Senior Network Manager independently and under minimal direction is responsible for negotiating and securing exclusive contracts, identifying and driving business acquisition or management opportunities, identifying opportunities and driving membership growth with current physicians and recruitment of new physicians, ensuring performance results with revenue driven and company wide initiatives, proactively resolving issues, and effectively communicating directly with both the physician and the office staff.
With approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California,
Texas and Rhode Island. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services.
Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. For 25+ years, Prospect Medical has been focused on our mission of supporting independent physicians where, through risk arrangements, we work closely together with health plans, facilities and healthcare physicians for the benefit of every person who comes to us for care. We provide
quality healthcare services that are designed to offer our patients highly coordinated, personalized care and that help them live healthier lives.
Prospect Medical Systems manages highly successful IPAs by leveraging our best-practices, results-driven administrative services to manage patients under risk arrangements with health plans/CMS. Minimum Education: Four (4) year college degree preferred. Minimum Experience: Minimum of three (3) years of HMO/IPA experience in Provider Relations or Contracting. IPA operations experience strongly recommended. Previous supervisory experience preferred. Internal candidates should be cross trained in the areas of Medical Management, Claims, Customer Service, Credentialing and Provider Relations.
Must be a Network Manager with Prospect and have met minimum performance requirements for advancement. Proficiency in word, excel, pivot tables. Typing 40 wpm. Excellent verbal communication skills and interpersonal skills. Able to establish rapport and interact well with individuals on all levels. Able to work with others while competing multiple tasks simultaneously and successfully. Maintain a professional image and attitude. Exceptional customer service skills. Working knowledge of IDX. Strong public speaking and presentation skills.
Able to prioritize and organize multiple tasks. Ability to make decisions in the absence of detailed instructions and work independently or in a team environment. Generating strong leads for new business development opportunities including new Medicare/Medi-Medi conversions and/or IPA conversions. Must possess a valid Driver's License. Must have advanced reasoning and problem-solving abilities and planning skills. Ability to interpret a variety of instructions furnished in written, oral, diagram, and schedule form. Ability to speak, read, and writes English proficiently.
Ability to write business correspondence. Ability to effectively present information and respond to questions from managers, employees, clients, customers and the general public. Demonstrate exceptional verbal/written/communication skills. Fluent in a foreign language that is applicable to any Prospect affinity network. Supervises or manages support staff as applicable. General performance benchmarks required to be considered for the Senior Network Manager position: Minimum of five (5) exclusive or semi exclusive contracts executed and/or business acquisition or viable management opportunities identified for senior management's review and consideration.
Each exclusive or semi-exclusive contract must yield net membership growth of 25+ seniors. Achieve a minimum of ten (10%) percent senior membership growth in assigned network. Eighty (80%) compliance of assigned network physicians actively participating in HCC program. Note: Proven and consistent results must have been demonstrated while performing duties of the Network Manager role. Req. Certification/Licensure: None. Identify opportunities to achieve membership growth by developing and capitalizing on relationships with physicians and pursuing business opportunities to support company wide revenue goals including but limited to the following: Identify and pursue standard, semi-exclusive and exclusive contracts with primary care physicians who have membership growth opportunities and lead successful execution and implementation plan.
Assist with procurement and recruitment of specialists and maintain active involvement in ensuring specialist network is market competitive to drive membership growth Develop sales call plan for assigned region and achieve physician and membership goals for assigned territory. Identify and pursue business acquisition opportunities for senior management to explore and act as liaison between Prospect and physician through the review and implementation process.
Identify management opportunities with IPAs and groups and directing leads to senior management for review and consideration. Performs/conducts Business Development functions to achieve membership growth to include: PCP recruitment, broker campouts, health plan representative and broker meetings, marketing strategies to promote growth, senior & commercial events, etc. Actively work with network hospital(s) to identify and recruit new PCPs and high-volume hospital admitters.
Recognize membership growth opportunities within established provider network and strategize methods to capitalize on growth via IPA consolidation, FFS Medi-Medi conversions into Managed Care product, Age in strategies, etc. Identify gains and losses and develop specific action plans to drive positive results for membership growth. Track and trend growth and losses and report to management. Conduct routine visits to all providers as outlined in department policies: 1) to ensure performance compliance with revenue driven initiatives,2) to engage in open face to face dialogue with physicians to communicate/educate important issues and updates, 3) ensure effective problem resolution, and 3) facilitate communication between the Provider Relations Department and Provider.
Ensure all assigned providers are compliant with company-wide initiatives including Encounter Data, HCC and P4P programs, membership growth, MLR targets, etc. Ensure provider is well educated about the programs and implement specific workflows to meet initiatives and produce positive results Track and report performance to measure results on an on-going basis and develop action plans for those non-compliant providers.
Ensure high level of participation by providers and office staff at all company events for education and training purposes. Oversee support staff to achieve compliance results with initiatives Conduct Office Manager Meetings for assigned network physicians and develop plan to ensure high level of attendance. Maintain positive business relationships to ensure retention of existing providers, therefore, decreasing the potential membership loss due to provider terminations. Timely report of any potential terminations and strategize to salvage relationship and/or retain membership.
Coordinate successful implementation of any membership transfers to ensure members remain with the company, to include developing transition plans with Member Relations to achieve the greatest retention of members, coordinating meet and greet functions with receiving physician office, developing member letters for receiving physician to send out, etc. Oversee the compliance and participation of network physicians to ensure providers are responding timely and accurately to global requests made by any and all departments within our organization including but not limited to the following.
Ensure physicians are pulling charts and/or making charts available for HCC chart audits or health plan audits Ensure physicians allow Facility Site Audits by any of our contracted health plans. Ensure all credentialing and re-credentialing information is received timely. Comply with production reporting requirements as stated in Department Policies and Procedures by required time frame. Analyze global performance of entire network across all departmental and company objectives and identify non complaint providers. Work well and develop relationships with Provider Relations Support Staff and other departments to effectively resolve issues that require root cause resolution from individuals within Prospect Medical.
Supervise, train and mentor new Network Managers to meet department and company objectives. Identify opportunities to achieve membership growth by developing and capitalizing on relationships with physicians and pursuing business opportunities to support company wide revenue goals including but limited to the following: Identify and pursue standard, semi-exclusive and exclusive contracts with primary care physicians who have membership growth opportunities and lead successful execution and implementation plan.
Assist with procurement and recruitment of specialists and maintain active involvement in ensuring specialist network is market competitive to drive membership growth Develop sales call plan for assigned region and achieve physician and membership goals for assigned territory. Identify and pursue business acquisition opportunities for senior management to explore and act as liaison between Prospect and physician through the review and implementation process. Identify management opportunities with IPAs and groups and directing leads to senior management for review and consideration.
Performs/conducts Business Development functions to achieve membership growth to include: PCP recruitment, broker campouts, health plan representative and broker meetings, marketing strategies to promote growth, senior & commercial events, etc. Actively work with network hospital(s) to identify and recruit new PCPs and high-volume hospital admitters. Recognize membership growth opportunities within established provider network and strategize methods to capitalize on growth via IPA consolidation, FFS Medi-Medi conversions into Managed Care product, Age in strategies, etc.
Identify gains and losses and develop specific action plans to drive positive results for membership growth. Track and trend growth and losses and report to management. Conduct routine visits to all providers as outlined in department policies: 1) to ensure performance compliance with revenue driven initiatives,2) to engage in open face to face dialogue with physicians to communicate/educate important issues and updates, 3) ensure effective problem resolution, and 3) facilitate communication between the Provider Relations Department and Provider.
Ensure all assigned providers are compliant with company-wide initiatives including Encounter Data, HCC and P4P programs, membership growth, MLR targets, etc. Ensure provider is well educated about the programs and implement specific workflows to meet initiatives and produce positive results Track and report performance to measure results on an on-going basis and develop action plans for those non-compliant providers. Ensure high level of participation by providers and office staff at all company events for education and training purposes. Oversee support staff to achieve compliance results with initiatives Conduct Office Manager Meetings for assigned network physicians and develop plan to ensure high level of attendance.
Maintain positive business relationships to ensure retention of existing providers, therefore, decreasing the potential membership loss due to provider terminations. Timely report of any potential terminations and strategize to salvage relationship and/or retain membership. Coordinate successful implementation of any membership transfers to ensure members remain with the company, to include developing transition plans with Member Relations to achieve the greatest retention of members, coordinating meet and greet functions with receiving physician office, developing member letters for receiving physician to send out, etc.
Oversee the compliance and participation of network physicians to ensure providers are responding timely and accurately to global requests made by any and all departments within our organization including but not limited to the following. Ensure physicians are pulling charts and/or making charts available for HCC chart audits or health plan audits Ensure physicians allow Facility Site Audits by any of our contracted health plans.
Ensure all credentialing and re-credentialing information is received timely. Comply with production reporting requirements as stated in Department Policies and Procedures by required time frame. Analyze global performance of entire network across all departmental and company objectives and identify non complaint providers. Work well and develop relationships with Provider Relations Support Staff and other departments to effectively resolve issues that require root cause resolution from individuals within Prospect Medical. Supervise, train and mentor new Network Managers to meet department and company objectives.
