Provider Network Manager
San Francisco Health Plan
The Provider Network Manager within San Francisco Health Plan (SFHP) works collaboratively to ensure an adequate network of qualified providers is available to satisfy member access, support providers with training and resources, and promote a positive attitude regarding participation in the SFHP provider network. The Network Manager ensure the design and implementation of programs that align with SFHP’s organizational goals, including expanding access to care. In this role, you will build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and community partners.
WHAT YOU WILL DO
- Maintain a leadership role in the relationship management and expansion of the SFHP provider network.
- Be primary contact for coordination of high-level provider issue resolution.
- Ensure effective partnership and coordination with key community partners.
- Work in conjunction with internal counterparts to proactively support network performance and process improvement.
- Analyze network composition and adequacy for the needs of SFHP’s membership; develop and implement strategies to address any deficiencies.
- Recruit new providers as necessary.
- Build and execute effective strategies to preserve and optimize existing network while aligning with SFHP strategic goals.
- Perform various provider related surveys such as timely access and provider satisfaction.
- Provide high-level input related to maintaining accurate and complete provider databases and provider directories.
- Continually improve provider engagement with SFHP’s outreach and education through Provider newsletter and site visits.
- Evolve SFHP’s provider-related tools and web-based services.
- The Network Manager is expected to use fact-based data to identify and solve a range of problems within the following areas of expertise:
- Investigate non-standard requests and problems, with some assistance from others.
- Prioritize and execute frequent on-site visits and meetings with physician groups or hospital systems, etc. and organize own work to meet deadlines.
- Provide explanations and information to others on topics within areas of expertise.
WHAT YOU WILL BRING
- Bachelor’s Degree in a health or business related field or equivalent work experience, Master’s preferred.
- Five years related experience in a managed care environment or health services organization; experience with provider network development and provider contracts.
- Experience in provider relations, provider outreach, and credentialing
- Knowledge of health insurance/managed care and CMS and State regulatory requirements
- Understanding of Medicare and Medi-Cal programs and benefits, the Provider appeal processes and reimbursement strategies
- Knowledge of claims processes and billing systems and Provider billing systems. DHCS/DMHC/NCQA
- Experience with presentations and leading diverse groups preferred
- Medical Plans: You’ll have a choice of medical plans, including options from Kaiser and Blue Shield of California. Employee-only coverage in the HMO plans are currently available at no cost and dependent coverage is heavily subsidized by SFHP.
- Dental: You’ll have a choice of a basic dental plan or an enhanced dental plan which includes orthodontic coverage.
- Vision: Employee vision care coverage is available at no cost.
- Time Off: 23 days of Paid Time Off and 12 observed company holidays.
- Professional development: Opportunities for tuition reimbursement, professional license/membership.
Established in 1997, San Francisco Health Plan (SFHP) is an award winning, managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco county. SFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 170,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services. SFHP was designed by and for the residents it serves and takes great pride in its ability to accommodate a diverse population that includes young adults, seniors, and people with disabilities.
San Francisco Health Plan is proud to be an equal opportunity employer. We are committed to a work environment that supports and respects all individuals and in which our processes are applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristics.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
San Francisco Health Plan is an E-Verify participating employer.
Hiring priority will be given to candidates residing in the San Francisco Bay Area and California.