Network Manager

Navihealth Fresno , CA 93707

Posted 2 weeks ago

Overview

Why navi

Health?

navi

Health is the result of over a decade of dedicated visionary leaders and innovative organizations challenging the status quo for PAC management solutions. We do healthcare differently and we are changing healthcare one patient at a time.

How might you ask? By hiring talented clinicians, engineers, analysts, and healthcare leaders to create and utilize cutting edge technology to provide the patient with the best level of care for the right amount of time.

Why Is This Role Critical?

nH recognizes the vital role providers play in enhancing our service delivery to the member. A highly engaged provider network is critical to ensure members receive the right care at the right place for the right amount of time.

The Network Manager (NM) is an integral part of the In-market leadership team, also including: General Manager, Senior Clinical Manager, and Clinical Team Manager. The NM develops and maintains an ongoing collaborative relationship with providers, based on mutual respect, high quality outcomes and patient satisfaction.

The NM works to continually shape the Network landscape, by offing objective data and education to all stakeholders in the market. In its highest functional state, it's the NM whom supports the provider in ensuring recognition by the hospital and plan partners through appropriate rate setting, improved volume and achieving and maintaining PAR/Contracted status. The NM plays a vital role in achieving positive outcomes in the market including but not limited to: SNF LOS, Discharges to PAR/Contracted Providers and Closing Clinical Records.

Responsibilities

What you will be accountable for.

Responsible to develop relationships with providers/payers and supporting the patient centric model during new implementations:

o Creates database of pre-implementation provider metrics (e.g. readmission rates, ALOS, etc.)

o Coordinates of implementation activities (scheduling dates/locations, speakers/attendees, contact points, deck preparation, status updates, etc.)

o Creates plan approved provider facing educational and summary documents

o Ensures all necessary logistics obtained to support a successful implementation (contacts, EMR access, onsite access, etc.)

o Coordinates onsite requirements for navi

Health colleagues (e.g. credentialing, legal requirements, etc.)

  • Responsible to maintain positive working relationships with providers/payers to build a high quality, highly receptive network base in mature markets.

o Serve as main point of contact for provider

o Delivers provider and hospital performance information at a regular cadence

o Holds providers accountable to:

Professional collaboration (based on collaboration agreement)

Timely delivery of clinical information

Supporting patient and family access to the nH Care Coordinator

o Evaluates provider receptiveness and quality

  • Responsible to lead network issue resolution

o Identifies challenging situations early and ensures appropriate action taken to mitigate escalation.

o Support providers as they have questions / concern / suggestions

o Solicits feedback as appropriate (focus groups, survey, coalitions)

o Works to resolve provider complaints at a local, regional and national level

  • Develop ongoing support materials for providers

o Preparation and analysis of dashboards for providers

o Coordination and delivery of dashboard information to providers (SNF and hospital as indicated)

o Provides ongoing education to providers that promotes quality service and collaboration

  • Works closely with General Manager and Senior Clinical Manager

o Monitors and works to improve:

hospital DC referral patterns

par and non-par SNF LOS

closed record statistics

o Reports challenges with care coordinators in the field

o May participate in network narrowing strategies

  • Works closely with VP Provider Engagement

o Analyzes data for trends in performance on a market, client, regional and national level

o Supports new and existing strategic network initiatives and programs

o Communicates network initiatives to providers

o Supports company specific initiatives as appropriate

o Supports the marketing of the nH brand

o Supports the onboarding of new network colleagues through mentorship

o Works with internal resources on development of preferred provider networks

o Supports and implements pay for value programs, as applicable

  • As indicated, assist with the development contracted networks

o Executing direct contracts with post-acute care providers

o Participating in contract negotiations and contract language review including redlining

o Managing contract load process

What you will need to be successful

o Bachelor's degree or equivalent;

o 5+ Years in a customer facing or Account Management Role

o Effective negotiation and influencing skills

o Detail oriented

o Ability to build and foster relationships inside and outside the organization

o Ability to independently plan, organize and prioritize work

o Willingness to work toward team objectives

o Ability to manage direct reports or team members

o Ability to make appropriate organizational determinations in accordance with nH standards of practice independently and timely

o Experienced in managed care, health plan operations in provider contracting, customer service, or provider relations

o Strong brand promotion and management skills

o Data analytics and reporting experience required

o Proficiency with Microsoft Office applications

o Experience in Acute and Post-Acute Care Continuum a plus

o Clinical Degree may be required, based on the needs of the market

o Extensive travel may be required

Qualifications

About Us

NaviHealth partners with health plans, health systems and post-acute providers to manage the entire continuum of post-acute care. We utilize evidence-based protocols to optimize care and bundled payment methodologies to align all stakeholders. The result: optimized care and outcomes, reduced inpatient days, reduced hospital readmissions, and increased patient satisfaction.

navi

Health Values

We care about the people we serve.

We care about each other.

We care about our communities.

We embrace innovation.

We like simple.

navi

Health is proud to be an equal opportunity/affirmative action employer. We are committed to attracting, retaining and maximizing the performance of a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

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Network Manager

Navihealth