Positions in this function are responsible for the development and/or on-going management and administration of clinical programs. Provides implementation support, measurement standards, and revisions as needed that incorporate applicable best practices with proven outcomes.
Initiates, manages, tracks deliverables, and completes special projects as assigned by the Vice President of Service Delivery and Regional Directors, or by the State
Collaborative (including Local Collaboratives, State Agencies, consumers, family members and other stakeholders regarding services funded by the Collaborative).
Works with all network providers, OHNM Regional Directors, State Agency Leads and Directors on local and statewide initiatives and projects to identify gaps in services, needed changes, implement best practices, improve quality, foster innovation, resolve issues and ensure accountability in the community or with OHNM.
Communicates regularly with providers, identifying and assisting providers to manage their funds and other best business practices. May perform network analysis and strategy development and implementation. Obtains data, verifies validity of data, and analyzes data as required. Analyzes network availability and access
Participates in provider, LC, quality and other meetings to assure that the service needs of individuals who receive services funded by the Collaborative are considered. Identifies unmet needs and community barriers and identifies and implements solutions to ensure that appropriate services are consistently provided under the contract.
Consults with the Finance, IT, Claims, Regional Directors, Program Directors and others as appropriate.
Manages, reviews and monitors Regional Director budgets on a monthly and year-to-date basis. Prepares required reports as needed.
May make recommendations regarding use, expansion, selection of networks for various products based on that analysis.
Coordinate of provider communication and training (in conjunction with local communication and training leads) to assure provider communication is timely, complete and delivered in methods that meet provider needs and leverages electronic transactions via the provider portal
Coordinates of provider reports to meet key state network deliverables and support the ongoing improvement of network adequacy and appropriateness.
Responsible for all Network GMs
Implements strategies to improve provider satisfaction, including coordination with local and national technical supports. Develops and manages relationships with key provider associations.
Identifies gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs (assuring alignment with state initiatives).
Assures network management and development activities meet customer requirements and support consumer needs, including establishing a continuum of care that support evidence-based practices.
Reviews the work of others.
Develops innovative approaches.
Sought out as expert.
Serves as a leader/ mentor.
UnitedHealth Group - 2 years ago
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