Sr Mgr-Network Operations

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

This position is remote/hybrid within the state of AZ only

PURPOSE OF THE JOB

Directly responsible for ensuring coordination of communications between the Medicaid Segment and the provider network while maintaining a sufficient provider network through provider satisfaction, continuous review of network adequacy, and provider demographic accuracy. Oversees Provider Services staff and ensures there is enough staff to enable providers to receive a prompt resolution to their problems or inquiries and appropriate education about participation in the Medicaid Segment network.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

1. Required Work Experience

Minimum of three (3) years experience working in network development

N/A

2. Required Education

Bachelors Degree in Health Care Administration, Business Administration, Finance, Economics, Accounting, or Management.

3. Required Licenses

N/A

4. Required Certifications

N/A

PREFERRED QUALIFICATIONS

1. Preferred Work Experience

N/A

2. Preferred Education

Masters Degree

3. Preferred Licenses

N/A

4. Preferred Certifications

N/A

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

Lead the team and projects on a proactive, timely, accurate, strategic, and independent basis while producing successful results.

Oversee and has direct accountability for relationship management, managing trends and provider issues, staff management, and provider database management for hospital, ancillary, and physician contracting.

Develop goals, work plans, and schedules for Provider Network Management staff and ensure that they are executed.

Routine, proactive, and meaningful interaction with internal departments, including, but not limited to Reimbursement Services, Clinical Operations, Prior Authorization and Member/Provider Services to ensure terms and/or provisions in executed contracts are implemented as intended.

Represent administration at provider meetings (JOC Meetings).

Achieve financial objectives.

Communicate job expectations to staff.

Plan, assign, monitor, and appraise employees job results.

Develop, implement, and enforce policies and procedures.

Maintain, train, orient, mentor, and evaluate staff.

Ensure staff have tools needed to be successful.

Set example of proper behavior and accountability to employees and serve as a role model for what is expected of a Medicaid Segment employee.

Annual department budget is prepared timely and adhered to.

Policies and procedures are updated annually (more often if necessary).

Staff is maintained at an adequate level and receives appropriate training to perform job

Staff have clearly defined and up-to-date job descriptions with specific goals and objectives.

Employee issues (performance, behavior, compliance with policies, etc.) are addressed timely and appropriately in accordance with company policies.

Valid Arizona Drivers license required as travel is required.

COMPETENCIES

REQUIRED COMPETENCIES

1. Required Job Skills

Experience with network operational systems and processes

Experience leading development of proactive and effective provider relations

Experience building and managing onsite and remote teams

Track record of improving processes, teams, and performance

Strategic and critical thinking skills

Problem solving/analysis

Strong Presentation Skills

2. Required Professional Competencies

Experience collaborating with teams, vendors, and resources

Independent decision-making abilities

Results-driven and client-focused

Initiative and proven organizational skills

Proactive problem-solver focused on quality improvement

Computer experience necessary

Effective interpersonal and communication skills

Ability to multi-task and prioritize work tasks to adhere to deadlines and identified time frames

Ability to manage a large workload

Ability to maintain positive work relationships, experience and knowledge of general health plan operations

3. Required Leadership Experience and Competencies

N/A

PREFERRED COMPETENCIES

1. Preferred Job Skills

N/A

2. Preferred Professional Competencies

N/A

3. Preferred Leadership Experience and Competencies

N/A

Our Commitment

AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.