at Health Care Service Corporation in Chicago, Illinois, United States
Job Description
At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.
Come join us and be part of a purpose driven company who is invested in your future!
Job Summary
This position is responsible for development and implementation of strategies for provider contract administration strategy, database accuracy, provider reporting, network management vendor relationships, provider and network management staff education and training, and project management. Develop or oversight of the development of policies and procedures in accordance with compliance and quality standards. Developing and implementing strategies for maintaining and improving provider satisfaction to members. Accountable for ensuring staff meets/exceeds goals, objectives and standards and have successful outcomes on projects and initiatives. Responsible for communications across the designated network management division. Represent the department in internal meetings and with external entities.
JOB RESPONSIBILITIES
Develop provider strategies and responsible for the implementation of provider strategies and initiatives in the following areas: provider contract administration/development and maintenance, special programs, vendor management, education and training, and new network project management.
Responsible for the development and oversight of the Network Management policies and processes while ensuring compliance and quality standards are achieved.
Develop, implement and maintain procedures for practitioner participation, network expansion, contracting and service. Ensure standards regarding the practitioner networks are met.
Communicate/report professional network issues and opportunities to the Network Management and Network Operations VPs and to peers in functional areas including FSUs, Marketing and Facility Provider Network Department.
Responsible for compliance with state and federal provider network requirements.
Coordination of new network/program activities through project management initiatives.
Coordination of physician fee schedule statewide updates.
Ensure staff is trained and meets/exceeds goals, standards, objectives and initiatives.
Prepare and maintain 1) Network Management presentations, and 2) provider reporting pertaining to network participation statistics, network composition, etc.
Support and coordinate outcomes with credentialing operations and ensure quality assurance programs are established and results meet/exceed expectations according to corporate policy. Attend Credentialing Committee meetings, as applicable.
Serve on local and corporate committees and task forces that require input from Network Management Department.
Responsible for hiring, training, firing, performance management, pay administration, talent management, professional development, change management and ensuring this position and the supporting management roles maintain knowledge of human resources programs, policies, processes and systems.
Manage communications for Network Management including coordination with Corporate Communications.
Communicate and interact effectively and professionally with co-workers, management, customers, etc.
Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
Maintain complete confidentiality of company business.
Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.
JOB REQUIREMENTS:
Bachelor Degree and 10 years managed care experience at the health plan level or hospital/health system level, including direct responsibility for health care administration / managed care.
5 years management experience at the director level including oversight of management/upper management.
Experience developing strategies and implementation of strategies /initiatives with successful outcomes.
Leadership skills to work across departments, lead professional and management staff, represent the department in internal and external meetings and drives results.
Extensive knowledge of health insurance... For full info follow application link.
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
