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Company:
CareSource
Posted: July 2, 2024
Job Summary:
The Health Partner Network Specialist II is responsible for implementation of strategic projects related to the Health Partner Transformation Program and other programs as required.
Essential Functions:
Work with cross-functional teams to ensure that processes developed are standardized and follow established work flows
Produce detailed reports on key accomplishments and provide notification of issues to upper management
Assist with implementation of new payment reform initiatives
Manage multiple projects, collect and analyze data and disseminate to appropriate departments as necessary
Create reports - such as a list of participating providers, or utilization; provide analysis of the data
Maintain responsibility for tracking network adequacy gaps in all Lines of Business on a weekly basis
Coordinate with operational units and Regulatory to avoid any adverse complications, such as fines, and provide Manager, Health Partner Contracting with weekly update on why the gaps exist, what is being done to resolve the issues, and an estimated time of completion
Assist in the review of providers appealing "closed panel" denials.
Assist in the loading of providers into the databases, including auditing the loads afterwards
Track the progress of major projects in order that update reports can be produced for review
Collaborate with internal resources to ensure projects remain on task for a timely conclusion
Perform any other job duties as requested
Education and Experience:
Bachelor's degree in Business Administration or related field or equivalent years of relevant work experience is required
Minimum two (2) years of experience in managed health plan industry is required
Two to three (2 to 3) years of experience in provider relations / services or related position is required
Two (2) years or more of project management experience is preferred
Provider contracting experience is preferred
Competencies, Knowledge and Skills:
Proficient with Microsoft Office to include Word, Excel and PowerPoint
Excellent written and verbal communications skills
Ability to develop, prioritize and accomplish goals
Strong interpersonal skills and high level of professionalism
Effective listening and critical thinking skills
Effective problem solving skills with attention to detail
Ability to work independently and within a team
Excellent leadership skills
Ability to create and maintain excellent working relationships
Licensure and Certification:
To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 - March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.
Working Conditions:
General office environment; may be required to sit or stand for extended periods of time
May be required to travel occasionally
Compensation Range:
$60,300.00 - $96,500.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type:
Salary
Competencies:
• Create an Inclusive Environment
• Cultivate Partnerships
• Develop Self and Others
• Drive Execution
• Influence Others
• Pursue Personal Excellence
• Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer, including disability and veteran status. We are committed to a diverse and inclusive work environment.
•
The Health Partner Network Specialist II is responsible for implementation of strategic projects related to the Health Partner Transformation Program and other programs as required.
Essential Functions:
Work with cross-functional teams to ensure that processes developed are standardized and follow established work flows
Produce detailed reports on key accomplishments and provide notification of issues to upper management
Assist with implementation of new payment reform initiatives
Manage multiple projects, collect and analyze data and disseminate to appropriate departments as necessary
Create reports - such as a list of participating providers, or utilization; provide analysis of the data
Maintain responsibility for tracking network adequacy gaps in all Lines of Business on a weekly basis
Coordinate with operational units and Regulatory to avoid any adverse complications, such as fines, and provide Manager, Health Partner Contracting with weekly update on why the gaps exist, what is being done to resolve the issues, and an estimated time of completion
Assist in the review of providers appealing "closed panel" denials.
Assist in the loading of providers into the databases, including auditing the loads afterwards
Track the progress of major projects in order that update reports can be produced for review
Collaborate with internal resources to ensure projects remain on task for a timely conclusion
Perform any other job duties as requested
Education and Experience:
Bachelor's degree in Business Administration or related field or equivalent years of relevant work experience is required
Minimum two (2) years of experience in managed health plan industry is required
Two to three (2 to 3) years of experience in provider relations / services or related position is required
Two (2) years or more of project management experience is preferred
Provider contracting experience is preferred
Competencies, Knowledge and Skills:
Proficient with Microsoft Office to include Word, Excel and PowerPoint
Excellent written and verbal communications skills
Ability to develop, prioritize and accomplish goals
Strong interpersonal skills and high level of professionalism
Effective listening and critical thinking skills
Effective problem solving skills with attention to detail
Ability to work independently and within a team
Excellent leadership skills
Ability to create and maintain excellent working relationships
Licensure and Certification:
To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 - March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.
Working Conditions:
General office environment; may be required to sit or stand for extended periods of time
May be required to travel occasionally
Compensation Range:
$60,300.00 - $96,500.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type:
Salary
Competencies:
• Create an Inclusive Environment
• Cultivate Partnerships
• Develop Self and Others
• Drive Execution
• Influence Others
• Pursue Personal Excellence
• Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer, including disability and veteran status. We are committed to a diverse and inclusive work environment.
•
Read the full job description and apply online on the recuiter's web-site
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