Manager, Provider Network Operations

FLSA Status: Exempt
Department: Provider Network Operations
Reports To: Director, Provider Network Operations

GENERAL DESCRIPTION OF POSITION
The Manager, Provider Network Operations is responsible for providing day-to-day management and leadership of the Provider Network Operations team responsible for establishing and maintaining excellent relationships with SCFHP’s provider network. This involves the development and execution of strategies related to communication, outreach, training, education, and service to the SCFHP provider network. The Manager designs and implements programs to build and nurture positive relationships with providers, staff and leadership of contracted health plans, physicians, hospitals, ancillary providers, IPAs, various types of health care facilities, and non-traditional medical providers. Responsibilities include conducting outreach to build relationships, conducting initial and subsequent provider orientations and ongoing training, troubleshooting concerns related to the provider’s contract or operational issues, and implementing ongoing quality and service improvement initiatives in support of a positive member and provider experience. In addition to the externally, provider facing interactions, the Manager works collaboratively with the Director, Provider Network Operations, representing the department at management and cross-functional meetings and interfacing with other departments as necessary. 

ESSENTIAL DUTIES AND RESPONSIBILITIES

To perform this job successfully, an individual must be able to perform each essential duty listed below satisfactorily.

1. Develop and maintain in depth market knowledge regarding the provider community in Santa Clara County.
2. Develop comprehensive training and resource materials related to SCFHP processes and procedures. This includes drafting and maintaining the SCFHP Provider Manual, website and provider portal content, provider newsletters, bulletins, tool kits, training materials, presentations, , and other planned and ad hoc provider communications. 
3. Create effective strategies for conducting provider outreach to provide timely information to the SCFHP provider network and to receive timely feedback from the network. Assure timely and appropriate responses to provider inquiries. 
4. Develop and conduct internal training across departments to assure appropriate knowledge and tools exist throughout the organization for servicing providers and understanding handoffs between departments. 
5. Represent the department at SCFHP committee meetings and workgroups. Act as a subject matter expert for cross-functional activities. Be the voice of the provider community at SCFHP, communicating the needs of the provider network as they relate to administrative processes, policies and performance.
6. Manage the Physician Advisory Council, developing relationships with participants, organizing meetings and agendas, in compliance with the Brown Act. Keep topics engaging and relevant to current health plan priorities including SCFHP’s Quality Improvement Health Equity Program, market trends and the regulatory environment.
7. Oversee the provider network associate’s responsible for Joint Operations Committee meetings with providers, ensuring the agenda topics are timely, relevant, engaging, and actions are documented and receive appropriate follow through.
8. Hire, manage and develop the provider network associate  team to ensure effective communication strategies, including timely, documented efforts related to education of new and existing providers, questions from providers, interventions addressing concerns regarding quality of service impacting health plan members, and action plans that pertain to specific initiatives with the SCFHP provider network.
9.  Coordinate with Provider Network Operations management to create seamless hand offs related to onboarding, credentialing and recredentialing of providers, contract implementation, Service Level Agreement (SLA) monitoring, and ensuring accurate set up and configuration in SCFHP systems. 
10. Communicate clearly and concisely with providers at all levels, including administration, the provider office staff and relevant vendors; convey information to internal departments and organizational leadership when appropriate.
11. Collaborate and work closely with the Manager, Provider Practice Transformation to conduct studies on operations, workflows, and fact gathering sessions with providers and transformation consultants to document, quantify, and specify quality improvement efforts. Work with providers and internal/external stakeholders to identify gaps and solutions to closing gaps between current and desired results.
12. Manage compliance with applicable regulatory and reporting requirements; monitor new requi