At Universal American, we are dedicated to a Healthy Collaboration, working together with healthcare professionals in order to improve the health and wellbeing of our members.
We have an exciting opportunity to join our organization and be part of the implementation and operation of Accountable Care Organizations (ACOs) aimed at increasing care coordination, improving quality of care and reducing costs for Medicare members. ACOs are designed to provide Better Care, Improved Health and Lower Per Capita Costs. Improved health will be accomplished through prevention and chronic care management. The aim of the ACO is intended to reduce the trend of cost increases associated with the Medicare fee for service population.
The Network Administrator will coordinate all activities of assigned Accountable Care Organization(s) or assigned provider network, including day-to-day monitoring of UM activities, financial reporting, contracting of provider and ancillary services, regulatory compliance and the overall management of an ACO/network to strategic goals.
Responsible for coordinating the development of professional, effective relationships within area hospitals, physicians and ancillary providers.
Responsible for the development and maintenance of educational materials and programs including provider manual, provider meetings/communications, ACO Board (as applicable), or other provider network meetings as determined by the market needs.
Assist in the development of the most appropriate network strategies including selection of quality, cost-effective providers including ancillaries and hospitals.
Plan, develop and manage ACO or Quality Compensation Program budgets including appropriate variance analysis.
Develop and maintain a close, effective working relationship with all Collaborative Health Solutions (CHS) corporate departments, continually updating ACO/network providers of operating policy and procedures for the ACO and CHS.
Organize, recruit, hire, train, supervise and effectively counsel the supporting CHS and ACO staff (as applicable.).
Assure that applicable operating policies, procedures and standards are appropriate, documented and followed.
Assure that applicable regulatory and compliance requirements are met in a timely and professional manner.
Assure that responsibilities are performed consistent with the deliberate plans of the ACO and CHS; maintaining a sensitive, caring and safe environment for customers, employees, providers and others, while operating within the limits of approved budgets.
Represent CHS and the ACO well at all times; support its mission, goals and objectives; participate as a “team player,” constantly supporting other managers; set an example of high personal and professional conduct for employees and others; maintain personal professional development; provide an atmosphere where employees can develop professionally, consistent with their abilities and the needs of the ACO and CHS.
Responsible for the development of comprehensive marketing programs for the market involving providers in Medicare and Commercial activities of managed care payers.
Develop a close working relationship with managed care payers positioning the network as a partner in their respective marketing processes, including support of area employer meetings, enrollment presentations, health fair5s and community events.
Work closely with contracted managed care payers in the development of marketing plans to achieve maximum return in membership growth for the network.
Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable, and defined in the Universal American Corporate and department policies.
And all other duties assigned by the manager and/or supervisor.
Professional verbal and written communication skills, with the ability to clearly articulate thoughts and ideas
Organizational skills with the ability to handle multiple tasks and/or projects at one time
Customer service skills with the ability to interact professionally and effectively with providers, third party payers, physicians, and staff from all departments within and outside the Company
Analytical and interpretation skills including departmental, utilization, financial and operations data
Decision-making skills with the ability to investigate and weigh alternatives and select the course of action that provides the greatest benefit to the organization
Creative thinking skills with the ability to ask the needed bigger-picture questions that lead to process and team improvements
Time management skills with the ability to prioritize and schedule daily activities for the most efficient use of time
Problem solving skills with the ability to look for root causes and implementable, workable solutions
Interpersonal skills with the ability to work in a fast-paced environment and participate as an independent contributor with little supervision or as an active team member depending on the situation and needs
Leadership skills with the ability to empower, engage, motivate, evaluate and manage team members individually and as a group
Must have a track record of producing work that is highly accurate, demonstrates attention to detail, and reflects well on the organization
Bachelor’s degree in business administration, related field, or applicable experience in a managed care organization
Five years’ progressively responsible experience in Provider Relations or related field
Personal computer experience should include working with Microsoft Word, Excel, PowerPoint and Outlook at the intermediate level at a minimum
Universal American Corp. is an Equal Opportunity / Affirmative Action Employer and does not discriminate because of age, color, disability, ethnicity, marital or family status, national origin, race, religion, sex, sexual orientation, military veteran status, or any other characteristic protected by law. We are committed to attracting, retaining and maximizing the performance of a diverse and inclusive workforce.