Job Description

Purpose:
The UPMC Health Plan has an exciting The Network Manager will support the Physician Account Executive (PAE) team and coordinate efforts with other HP clinical departments. They will assist with provider operational initiatives including HCC, CDPS, MA P4P, and CMS Stars. The Network Manager will outreach to providers as related to key departmental goals via phone, email and personal visits. They will assist in obtaining provider information and document their activity in a customer database. The Network Manager will assist in investigating claims issues and effectively communicate their findings to providers and external departments.

This role is Hybrid and will require an onsite presence a minimum of 3 days per week

Responsibilities:

• Coordinate provider problem resolution as identified through internal reports and by the PNL team or ISD leadership. Identify root causes, swiftly take the needed steps to resolve the issue and ensure closed feedback loop to the PNL and provider occurs.
• Present health plan programs and tools to network providers and their office staff. Follow up with provider as necessary to ensure understanding. Document provider outreach and initiative progress in a customer relationship database in a timely manner.
• Ability to manage relationships with key accounts within the Health Plan physician network is preferred.
• Collaborate with other Network Leaders and staff to ensure process improvement within department.
• Coordinate problem resolution for providers as necessary and ensure ongoing collaboration with providers.
• Present various HP programs and tools to network providers and staff. Follow up with provider as necessary.
• Effectively manage special projects assigned by Manager, Department Director, Team Leads and Physician Account Executives.

Qualifications:

• Bachelor's Degree in Business, Health Care, Marketing or a related field is required or equivalent experience.
• Three years business/sales or healthcare-related experience required.
• Driver's license required.
• Strong written and verbal communication skills are required.
• Demonstrated leadership, planning, communication, documentation, organization, analytic and problem solving abilities are required.
• Ability to attend or accompany Manager/ PAE to various internal and external department and provider/hospital meetings.
• Effectively interpret and summarize results of various analyses in a timely manner.
  UPMC is an Equal Opportunity Employer/Disability/Veteran

Job Tags

Work at office, 3 days per week

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