Provider Quality & Network Development Manager - Yoh Services, LLC

Employment Type

: Full-Time


: Non-Executive Management

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Provider Quality and Network Development Manager needed for a permanent opportunity with Yoh s client located in Scotts Valley, Salinas or Merced, CATop Skills Should You Possess Experience with navigating a provider system Experience in rate negotiation processes Supervisory experience What You ll Be Doing Manage provider network evaluation and development, reporting, and compliance-related activities, with duties including, but not limited to: Identifying and monitoring opportunities for access, quality, and regulatory improvement, including analyzing the adequacy of the Alliance provider network in meeting members needs Analyzing data and identifying member needs in order to develop annual and ad hoc network expansion plans for execution by the Provider Relations unit Developing network gap analyses for new programs or lines of business for recruitment execution by the Provider Relations unit Managing the delegate oversight process to ensure network adequacy and overseeing efforts to ensure network access standards are met Developing and auditing regular reporting at the individual provider and network levels to evaluate adequacy of individual providers, the Alliance provider network, and Alliance delegated networks Manage, supervise, mentor and train staff, with duties including, but not limited to: Managing and supervising staff, setting goals and objectives, delegating and assigning work Providing mentoring, coaching, and development and growth opportunities to staff In conjunction with the Provider Services Director, interviewing and participating in the selection of staff Evaluating employee performance, providing feedback to staff, and coaching and counseling or disciplining staff when performance issues arise Overseeing or conducting staff training, including the development and maintenance of training materials, in conjunction with the Training and Development team Overseeing operational work for Provider Services, including regulatory reporting, policy review, project participating, and training, with duties including, but not limited to: Overseeing the coordination and management of the regulatory reporting process, including coordination and creation of deliverables for audits and the annual Medi-Cal network certification Auditing routine and regulatory reports, with a focus on quality, to ensure completeness and accuracy Managing the annual policy review process for Provider Services Participating in high-level workgroups and projects and serving as a Provider Services resource and subject matter expert What You Need To Bring To The Table Bachelor s degree in Healthcare Administration, Business Administration, Public Administration, or a related field AND a minimum of six years of experience (or a Master s degree AND a minimum of four years of experience) in managed care A minimum of three (3) years of management level experience related to program evaluation and/or data evaluation and a minimum of two (2) years of supervisory experience An equivalent combination of education and experience may be considered Thorough knowledge of the tools and techniques of data analysis and reporting Working knowledge of the healthcare industry and healthcare planning Working knowledge of the California Medi-Cal program and entitlement programs, the tools and techniques of gap analysis, program and project management, and the principles and practices of supervision and training Ability to navigate Windows-based PC systems and Microsoft Word, Outlook, PowerPoint, and Excel Ability to foster working relationships and provide leadership Ability to manage the development and implementation of projects, analyze data and prepare written and oral reports, and develop training materials Excellent written and verbal communication skills; sound judgment Working knowledge of the principles and practices of provider network evaluation preferred What are you waiting for? Apply NowRecruiter: Liyi StralyYoh makes finding and applying for jobs simple. Partner with Yoh to find the right opportunities across multiple industries in the US and UK. Find out more hereYoh, a Day & Zimmermann company, is an Equal Opportunity Employer, M/F/D/V. Click here to contact us if you are an individual with a disability and require accommodation in the application process.

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