Network Manager - North Central (Hybrid)

UPMC Community Care Behavioral Health is hiring a full-time Network Manager to support the North Central Network Management team. This position follows a hybrid schedule, requiring in-office presence 3 days per week - Monday, Wednesday and Thursday. Candidates may work from any of the following office locations: Dubois, Moosic, or State College. Occasional travel will be required. 

The Manager, Network leads a team of professionals to work in collaboration with network providers to ensure delivery of high quality, cost efficient behavioral healthcare services to mutual customers of Community Care. Establishes goals for the department that lead to not only the department's success, but also the overall success of Community Care. Interacts with other internal and external customers to set appropriate goals and establish priorities for the Network Management staff. Prepares and organizes deliverables required for the assigned network(s)

Responsibilities:
 

• In collaboration with Senior Director Network and Regional Director, recruit, train, supervise and evaluate staff assigned to contract.
• Conduct Individual Provider Orientation/Service meetings to review Authorization procedures, billing requirements as well as a review of Member rights/responsibilities.
• Investigate Licensing Regulations and/or HealthChoices Regulations when presented with provider specific questions.
• Prepare all network agenda items for clinical-operations meetings and follow through with any required action items.
• Serve as the point person for all provider related inquiries (with the exception of direct claims related questions). This includes, but is not limited to, issues related to the following:Credentialingnetwork expansionfee schedulesregulationsAllowable billing activitiesPROMISe related matters
• Prepare all contract related network deliverables, including but not limited to Geo-Access reports and waivers, RAI/PEPS information and any on-going monitoring of network activity.
• Oversee all network expansion activities for new and existing providers including the following: Developing financial impact analysis Obtaining verification of specialization Reviewing information at Clinical Operations Meeting Reviewing credentialing information Submitting Supplemental Service Enrollment Applications to the State on behalf of the Provider Assist Providers in Service Description Development
• Coordinate problem resolution for providers as necessary and ensure ongoing collaboration with providers to support Community Care initiatives.
• Collaborate consistently with Regional Director to prepare for and present network updates at OMHSAS monitoring meetings.
• Develop written communication following provider meetings in which quality of care concerns are discussed.
• Participate in meetings with the County Administration (and/or HealthChoices oversights) who are the direct contract holders for the Medicaid contract with the state.
• Ensure ongoing provider communication through the facilitation of Provider Advisory Committee Meetings (including responsibility for the following: creating agenda, presenting information, leading discussion) to large groups of providers in the respective contracts.
• Participate and prepare materials for Office of Mental Health and Substance Abuse (OMHSAS) Monitoring Meetings
• Oversee daily activities of staff to ensure compliance with workflows and timeframes