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Pacific Medical Centers Supervisor Network Contracting and Provider Relations in Seattle, Washington

Description:

Find what you’re looking for in your career, at PacMed as a Supervisor Network Contracting and Provider Relations (1.0 FTE, Day Shift) to work in Uniformed Services Family Health Plan at Seattle, WA

The Supervisor of Network Contracting and Provider Relations is responsible for the development and maintenance of the Network Plan the provider handbook, for evaluation of the adequacy of the network, for assuring that the network meets URAC and DoD standards, and that there is compliance with all elements of the TRICARE Management Activity contract. Understands the attitudes and values of the community and establishes effective working relationships with stakeholders to increase resources and collaboration. Acts as a representative and spokesperson for US Family Health Plan both internally and externally. Responsible for assuring providers and network members are educated in Health Plan criteria and processes. Responsible for the non-clinical utilization management functions of the Health Plan. Responsible for compliance with the DoD contract regarding network and utilization issues. Responsible for a key role in provider contracting and network relations.

In this position you will:

  • Responsible for the continued development and implementation of the Network Management Plan per URAC and DoD guidelines.

  • Understands the attitudes and values of the community and establishes effective working relationships with stakeholders to increase resources and collaboration

  • Responsible for assuring providers and network members are educated in Health Plan criteria and processes and acts as the primary resource for orientation and coaching for performance improvement.

  • Responsible for a key role in provider contracting and network relations. Acts as a representative and spokesperson for US Family Health Plan both internally and externally. Maintains ongoing contact with providers through on-site visits, phone and written communications.

  • Communicate effectively with internal constituents on reimbursement strategies, mechanisms to improve payer compliance, and to communicate status and outcomes of negotiations.

  • Utilizes knowledge of the medical community to source medical groups for the USFHP network. Evaluates the appropriate medical groups, and makes recommendations to management about which groups to include. Leads contact negotiations and completes the contracting process with new network providers and assures the successful implementation of negotiated contracts.

  • Responsible for the Health Plan’s non-clinical utilization management program referral management, and providing education and oversight to the clinic based referral coordinators.

  • Communicate effectively with internal constituents on reimbursement strategies, mechanisms to improve payer compliance, and to communicate status and outcomes of negotiations.

Qualifications:

Required qualifications for this position include:

  • Five (5) years experience in managed care operations.

  • Extensive experience and understanding of capitated medicine, contracted networks and health plan

Preferred qualifications for this position include:

  • Bachelor's Degree in related field

  • Ambulatory medicine experience

  • Project Management

  • Contract Negotiation

Pacific Medical Center:

Pacific Medical Center is an expanding network of outpatient clinics providing primary and specialty care to the greater Seattle area and employing more than 150 providers representing most medical specialties. Pacific Medical Centers is affiliated with Providence Health & Services, which operates 28 exceptional not-for-profit hospitals and more than 350 clinics across the West. With hundreds of physician and advanced practice provider opportunities in virtually all specialties at any given time, Pacific Medical Centers and Providence offer diverse locations, lifestyles and practice models. Find what you are looking for in your next practice opportunity with Pacific Medical Centers! Learn more at www.pacmed.org/providerjobs .

We offer a full comprehensive range of benefits — see our website for details —

http://pacmed.jobs/benefits/

Our Mission

Our mission is to provide respectful, high-quality, patient-focused healthcare to each person and to the communities we serve.

About Us

Quality and respect. These are the words Pacific Medical Centers (PacMed) employees live and work by. PacMed is a private, not-for-profit, primary and integrated multispecialty health care network with 10 outpatient clinics across the Puget Sound region and more than 175 primary and specialty care providers. Affiliated with the Providence Health & Services system, PacMed provides patient-focused health care — and even same-day appointments — to patients in King, Snohomish and Pierce counties. We provide immediate access to cutting-edge technology, first-class facilities and board-certified specialists, many of whom have been listed as among “Seattle’s Best Doctors.”

Pacific Medical Centers, PacMed, and their Affiliates' (collectively “PacMed”) comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex. PacMed does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Schedule: Full-time

Shift: Day

Job Category: Non-Clinical Lead/Supervisor/Manager

Location: Washington-Seattle

Req ID: 290504

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