Health Net, Inc. is a publicly traded managed care organization that delivers managed health care services through health plans and government-sponsored managed care plans. Its mission is to help people be healthy, secure and comfortable. Health Net, through its subsidiaries, provides and administers health benefits to approximately 5.4 million individuals across the country through group, individual, Medicare (including the Medicare prescription drug benefit commonly referred to as "Part D"), Medicaid, U.S. Department of Defense, including TRICARE, and Veterans Affairs programs. Health Net's behavioral health services subsidiary, Managed Health Network, Inc., provides behavioral health, substance abuse and employee assistance programs to approximately 4.9 million individuals, including Health Net's own health plan members. Health Net's subsidiaries also offer managed health care products related to prescription drugs, and offer managed health care product coordination for multi-region employers and administrative services for medical groups and self-funded benefits programs.
For more information on Health Net, Inc., please visit the company's website at
The Provider Network Manager manages provider networks for adequacy and access. Conducts high level negotiations and renegotiations of provider contracts. Monitors network adequacy and resolves hospital provider claim issues. Provides regional input and maintenance of provider directory listings. Participates in monthly internal/external meetings involving network activity. Monitors areas credentialing process. Develops provider contracting strategy.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Oversees network development and retention strategizing.
Oversees network problem resolution (Claims, UM, Etc.).
Oversees network analysis for adequacy and recruitment targets.
Oversees provider contract negotiations - hospitals, ancillaries, and groups.
Provides financial analysis for network development targets.
Bachelor's degree required; Master's degree preferred (MBA, MHA).
Five to seven years in administration and/or negotiation of managed care contracts.
Knowledge, Skills & Abilities:
Knowledge of principles and processes of managed care lines of reimbursement methodologies.
Strong verbal and written communication skills.
Computer skills (including Excel, Access, Word).
Ability to be a team player and team leader.
Ability to focus on overall task while balancing a multitude of priorities.
Demonstrated skills in contract negotiations.
Demonstrated analytical skills.
Ability to establish credibility with hospitals, physicians and MTF staff.
Demonstrated ability to effectively deal with difficult and complex negotiations.
Knowledge and understanding of MHS/TRICARE.
Ability to train and mentor indirect staff.
The following section describes the general physical requirements for this position. Please note that 'constant' refers to more than 81% of time; 'significant' refers to 40-80%; and 'moderate' refers to 20-40% of the time.
Operates personal computers, printers, facsimile, telephones, copy machines and other commonly used office accessories/equipment.
Exposed to confidential information and expected to maintain confidentiality at all times; must adhere to HIPAA rules and regulations.
May be required to work outside of normally scheduled hours as mandated by the client, project and/or workload (e.g. evenings, weekends, and/or holidays).
May be required to maintain established work pace, meet deadlines; may have last minute urgent requests.
Physical activity may include: twisting, reaching, kneeling, bending, stooping, squatting, crawling, grasping, grabbing, pushing, pulling, repetitive motion, climbing, etc.
Required to have visual acuity to determine the accuracy, neatness, and thoroughness of the work assigned.
Required to have hearing ability to receive detailed information through oral communication.
Required to have speaking ability to express or exchange ideas.
Constant concentration may be required on various subjects by listening, reading and thinking clearly.
Interaction with others may be required. May need to listen, think, and speak in order to interact with others. Business interactions and behavior between coworkers and/or external customers are required. This may require face-to-face or telephone interactions.
Thinking at work may include listening, learning, analyzing, evaluating, and the ability to interpret what is seen and/or heard, or to link information from one issue to the next.
Constant computer usage including typing and/or eye strain.
Constant repetitive arm, wrist, hand and finger motions -- making repetitive movements (e.g. key boarding, filing, data entry).
Constant phone usage; headsets may be required.
may be required between work sites and/or out of area.
Constant sedentary work (desk bound or seated).
Constant reading is required via computer screen and/or bound printed materials
As a government contractor, this position requires U. S. citizenship and proof of favorable adjudication following submission of Department of Defense form SF86 or higher security.
Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.
Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening.
Health Net and its subsidiaries are an Equal opportunity/Affirmative Action Employer M/F/V/D.
Health Net - 5 months ago