Immanuel Provider Network Manager - Full time Days - Immanuel Pathways Central Iowa in Windsor Heights, Iowa
Develops and manages provider network and contractual relationships with service providers for Immanuel Pathways, ensuring that providers understand the role and responsibility and maintain ongoing compliance with policies and procedures as required by PACE regulations. The Provider Network Manager is responsible for contract terms, rate negotiations and ongoing management of contracts while also ensuring a comprehensive network of providers is maintained for Immanuel Pathways. Serves as a key liaison between Immanuel Pathways staff and contracted providers. Supports and lives out Immanuel’s Mission and CHRIST Promises.
Key Responsibilities and Duties of the Job
75% Contract Administration & Provider Liaison
Manages and monitors the contracted services relationships and rates for the PACE provider network.
Develops contractual relationships with services providers, confirming and/or negotiating rates, drafting contract agreements, and maintaining an adequate PACE provider network for Immanuel.
Facilitates service need requests for contracted providers from Centers including requests for additional providers in network.
Manages provider network as the contract liaison to address provider/Immanuel Pathways concerns in a timely and efficient manner.
Coordinates and monitors on-site annual quality reviews of all contracted providers.
Coordinates and completes HIPAA business agreements, with providers as appropriate or requested.
Conducts appropriate follow-up with pending providers to ensure timely implementation of contracts.
Provides the initial provider orientation training to all contracted providers. Ensures documentation of training and proper filing of information for annual PACE audit.
Ensures audit checklist is completed following the implementation of all contracts.
Provides updated PACE training materials to contracted providers, at least annually, to person(s) responsible for new and ongoing staff training to ensure ongoing education of all contracted staff.
Provides education, at least annually, on PACE model and obtains a signed attestation from the person(s) responsible for ongoing staff training and education acknowledging receipt of training materials and responsibility for training all new staff.
Provides, at a minimum, quarterly touchpoints with all contracted vendors, providing ongoing education, and organizational updates.
Assists the Compliance Department with maintaining a provider database to communicate appropriate contract information, including responsibility for updating provider information in the PACE Organizations consolidated managed care system.
Communicate contracted vendor status changes to Executive Director, Medical Director and IDT in a timely manner.
Communicate contracted vendor contract revisions to Executive Director, Medical Director and IDT in a timely manner.
Ensures compliance of CMS required PACE obligations with all contracted providers.
Works with the Compliance Department to ensure contract compliance with State and Federal regulations.
Maintains compliance with established departmental and organizational policies, procedures and objectives.
Follows all Immanuel Pathways policies and procedures and OSHA safety guidelines.
Participates in all safety, security and infection control programs that are mandatory as well as those required and provided by Immanuel Pathways-PACE.
Maintains and promotes a professional attitude by providing safe and effective support and assistance to co-workers in the delivery of participant care
Maintains the confidentiality of all company procedures, results, and information about participants and staff including faxed information and courier materials.
Maintains safe working environment. Follows all fire and safety guidelines.
Participates in continuing education classes and any required staff and training meetings.
Participates in PACE Center Quality Improvement initiatives.
Performs other duties as required or requested.
Maintains professional affiliations and any required certifications.
Post high-school education is required.
Bachelor’s degree in business administration, marketing or related field is preferred.
Two (2) years’ experience in a higher level administrative role, preferably in the healthcare industry, is required.
One (1) year of experience working with the frail or elderly population required, or completion of job specific training related to working with the elderly population must be completed within the first six months of hire.
Previous business or healthcare management experience preferred.
Previous experience with contract negotiation is preferred.
Equivalent years of education may substitute for experience requirement.
Must have medical clearance for communicable diseases and up-to-date immunizations before having participant contact.
Must have a valid driver’s license, proof of insurance and have reliable means of transportation.
Basic Life Support (BLS) Skills i.e. Health Care Level Cardiopulmonary resuscitation (CPR); Automated External Defibrillator (AED); First Aide (FA).
Agree to abide by the mission, promises, philosophy, practices, and protocols of Immanuel as well as specific community or center.
KSA-Knowledge, Skills, Abilities-
Knowledge of managed care networks.
Ability to develop and maintain successful relationships within a managed care network.
Knowledge of the contract negation process and skilled at contract negotiation.
Knowledge of professional and institutional medical contracts including their coding preference, credentialing, and regulatory statutes preferred.
Knowledge of safety, privacy and compliance requirements for healthcare facilities.
Word processing skills, data collection skills and knowledge of basic statistical principles.
Skilled in identifying and recommending problem resolution.
Skilled in written and oral communication.
Skilled in utilizing software applications
Ability to apply and adapt skills and knowledge acquired through training and development opportunities.
Ability to establish and maintain effective working relationships with outside medical vendors and coordination of their activities with internal departments.
Ability to confer and consult to obtain effective, code definable and regulatory compliant contracts with both professional and institutional vendors on behalf of Immanuel Pathways PACE Centers.
Must have the ability to navigate through contracts and manage outside vendor contracts and maintain them in consolidated managed care system.
Ability to coordinate all credentialing activity within the PACE center and between contracted vendors and internal and external credentialing review entities.
Ability to chart via Electronic Health Records.
Proven experience and basic computer proficiency (internet, email, Microsoft Office)
Posting Title: Provider Network Manager - Full time Days - Immanuel Pathways Central Iowa
Job ID: 2020-4111
External Company URL: www.immanuel.com
Street: 7700 Hickman Road