Network Management and Member Services Manager - Campbell, United States - HCA Healthcare

HCA Healthcare
HCA Healthcare
Verified Company
Campbell, United States

3 weeks ago

Mark Lane

Posted by:

Mark Lane

beBee recruiter
Description

Salary Estimate:
$ $ / year

Learn more about the benefits offered for this job.


Introduction:


Do you want to join an organization that invests in you as a(an) Manager Data Management? At HCA Healthcare, you come first.

HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years.


Benefits:

HCA Healthcare, offers a total rewards package that supports the health, life, career and retirement of our colleagues.

The available plans and programs include:

  • Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
  • Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, longterm care coverage, moving assistance, pet insurance and more.
  • Free counseling services and resources for emotional, physical and financial wellbeing
  • 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
  • Employee Stock Purchase Plan with 10% off HCA Healthcare stock
  • Family support through fertility and family building benefits with Progyny and adoption assistance.
  • Referral services for child, elder and pet care, home and auto repair, event planning and more
  • Consumer discounts through Abenity and Consumer Discounts
  • Retirement readiness, rollover assistance services and preferred banking partnerships
  • Education assistance (tuition, student loan, certification support, dependent scholarships)
  • Colleague recognition program
  • Time Away From Work Program (paid time off, paid family leave, long
- and short-term disability coverage and leaves of absence)

  • Employee Health Assistance Fund that offers free employeeonly coverage to fulltime and parttime colleagues based on income.
Learn more about Employee Benefits


_ Note:
Eligibility for benefits may vary by location._
You contribute to our success. Every role has an impact on our patients' lives and you have the opportunity to make a difference. We are looking for a dedicated Manager Data Management like you to be a part of our team.


Job Summary and Qualifications:


GENERAL SUMMARY OF DUTIES:

The Manager of Network Management and Member Services is responsible for overseeing the operational activities of the Network Management and Member Services departments


What you will do:


  • Supervises a staff consisting of Network Management Associates both in house and remotely, and a Network Management Coordinator whose primary function is to provide provider support/education and interaction with contracted Health Plans (HMO and PPO)
  • Responsible for managing network provider education of applicable policies and procedures
  • Responsible for supervising daily provider inquiries, including capitation and reimbursement issues
  • Assist in development of physician communication programs and strategy
  • Responsible for maintaining strong relationships with contracted Health Plans (HMO and PPO) Communicates with payors and network providers, both orally and written, in association with operational and contractual related issues
  • Oversees client related projects
  • Assist in identifying issues, problems, and areas where performance could be improved
  • Represent PPMSI at physicians' offices, contracted health plans, and committees when necessary
  • Develop and present educational pieces at network provider meetings
  • Primary responsibility for periodic statistical performance reporting of Network Mgt activities
  • Insure adequate physician network retention, expansion and recruitment
  • Assist with the development of strategic plans for servicing network physicians and members
  • Develop, recommend, and implement new policies and procedures when appropriate

What you will need:


  • Advanced knowledge of managed care market, strategies, and physician compensation models
  • Working knowledge of medical group/IPA operations
  • Excellent verbal and written communication skills
  • Excellent public speaking and interpersonal skills
  • Able to present oneself professionally and have the ability to address large groups of people in educational forums
  • Strong research and analytical skills
  • Able to research complex contractual documents for interpretive purpose and utilize critical thinking skills
  • Willingness to travel locally
  • Knowledge of claims payment systems
  • Possess excellent problemsolving skills and is able to identify and adapt to shifting priorities

Education:


  • Bachelor's degree in business, health care or related field, or equivalent experience required

Experience:


  • Four to Five years in health care setting, including progressively more responsible experi
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