Network Manager II - Nashville
Location: Nashville Tennessee
Description: BlueCross BlueShield of Tennessee is employing Network Manager II - Nashville right now, this position will be placed in Tennessee. More complete informations about this position opportunity kindly see the descriptions. This position is located in Nashville, TN.
General Summary
To facilitate positive, professional relationships with BCBST providers and with BCBST thro! ugh proactive communication, education and problem resolution.
Job Duties & Responsibilities
Proactively serve and educate contracted physicians, hospitals, ambulatory surgery centers, ancillary, organizational, and health care practitioners on preferred BCBST policies, procedures, technologies and contractual obligations through site visits and workshops. Network Manager II employees typically manage all providers, including multiple large and complex providers.
Evaluate network needs, identify targets and coordinate the contract needs for standard provider contracts through the Network Representative and PSO to ensure adequate networks for each BCBST product line based on established adequacy and reimbursement targets.
Evaluate needs, identify targets, contract with providers and coordinate facility/ancillary negotiations determined to be nonstandard within the assigned territory, to ensure adequate networks for each BCBST product line ! based on established adequacy and reimbursement targets.
Lead components of negotiation process for assigned providers.
Become subject matter expert and conduct training on Relative Value Analysis (RVA)
Consult with provider partners on preferred business practices to assist with the effective management of BCBST members.
Proactively facilitate interaction between providers and appropriate BCBST departmental staff for clarification or correction of major provider concerns and/or issues; follow issue through to resolution with subject matter experts and close issues/inquiries out with the provider. Identify trends and coordinate to reduce friction between BCBST and provider.
Maintain routine contacts with critical provider partners within assigned territory.
Actively participate in healthcare community where BCBST representation can enhance long-term relationships with our provider partners.
Mentor junior staff members
Collaborate with internal divisions, including! but not limited to: Healthcare Services, Marketing and Customer Service, to understand and participate (where appropriate) all issues related to providers and healthcare community within assigned territory.
Manages own calendar; conducts analyses and makes recommendations on next steps. Works independently on most routine and non-standard issues, seeks counsel on more complex issues, projects, and initiatives
May perform all responsibilities for Network Manager I, including leading Operations Meetings, representing the department in internal initiatives, and facilitating sessions/speaking at provider workshops.
Qualifications
Education
Bachelor’s Degree in Business or Healthcare Administration or equivalent experience required. Equivalent years of experience are defined as a year of professional experience for every year of college requested.
Experience
Minimum 5 years experience with provider contracting in ! the health care industry required.
Experience with medical ter! minology, contract language and reimbursement methods required.
Skills/Certifications
Completion of AHIP Academy for Healthcare Management (AHM) courses preferred â€" 1.) Healthcare Management: An Introduction, 2.) Network Management, 3.) Medical Management, and 4.) Health Plan Finance & Risk Management PAHM coursework preferred
PAHM coursework preferred.
Ability to maintain high level of professionalism by demonstrating excellent written and verbal communication skills with both internal and external customers.
Persuasive presentation skills required.
Self-motivated and able to manage multiple tasks and priorities within specified timeframes.
Strong computer skills, to include word processing, spreadsheet and database management.
Strong organizational skills and attention to detail required.
Able to work independently and as part of a team.
Able to travel to provider offices.
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If you were eligible to this position, please email us your resume, with salary requirements and a resume to BlueCross BlueShield of Tennessee.
If you interested on this position just click on the Apply button, you will be redirected to the official website
This position starts available on: Mon, 10 Jun 2013 13:20:21 GMT