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Job: ACO Administrator Manager

This posting has expired and is no longer available.

Job Description

JOB SUMMARY:  The PODS Administrator Manager is directly responsible for the development, adequacy, implementation and management of Physician, Hospital, and Ancillary network providers.  The PODS Administrator Manager oversees and is responsible to provide education, training, and management to the PODS Administrator team to ensure PODS Administrators achieve established goals within their geographical POD, including network adequacy, achieving membership growth targets, meeting financial parameters for medical expenses, and financial performance within the POD.  Frequent travel to Provider offices is required.  This position requires initiative and assertiveness when dealing with POD goals and performance.  Sound and objective decision making must be exercised in all interactions with providers, payer partners, and internal departments.  The PODS Administrator Manager also leads Network initiatives such as provider education for new payer implementation, opt-in processing, etc. 

Job Responsibility:
Oversee all PODS Administrators to ensure that network providers satisfy financial goals within the assigned POD.  Develop provider strategies including, but not limited to:
* Participating in and leading Physician Advisory Council (PAC) meetings. 
* Develop and communicate strategic initiatives to strengthen the financial position of the POD.
* Perform in-service/education to providers
* Ensure providers are following proper medical procedure and referral, information/authorization, covered service guidelines, and submission of claims.
* Utilize reporting, including developing new reports and available data to facilitate data sharing and improve performance within the POD
* Other Duties as Assigned
Oversee the POD Administrator team to develop, monitor, administer, maintain, and manage the physician, hospital, and ancillary provider network within all PODs:
* Analyze and evaluate network coverage to identify network needs
* Understand and explain contract opportunities to providers through the Messenger Model process
* Other duties as assigned
Develop and implement provider education campaigns around new payers, opt-ins, and other initiatives. 
* Analyze and evaluate provider education needs, including reporting and provider tool-kit materials
* Understand and explain contract opportunities to providers through the Messenger Model process
* Other duties as assigned
    
Expected Outcomes:
* Leads PAC meetings and facilitates impromptu meetings as required.
* Develops strong relationships with hospital leadership as well as provider groups
* Provides orientation to new providers within 30 days of contract execution.
* Providers understand and actively work to maximize contract opportunities
* Responds to requests for research and resolution to complaints.
* Communications and items disseminated are complete and accurate.
* Employees have clearly defined job descriptions, goals, and objectives. 
* Network coverage is analyzed and evaluated to ensure network adequacy.
* Service gaps are identified and a strategy is developed and implemented to cover such gaps.
* PODS Administrators have consistent and concise messaging to the provider network
* New payer opt-ins and contract documents are delivered and processed efficiently within required timelines

Health Choice exists to improve the health and well-being of the individuals we serve through our health plans, integrated delivery systems and managed care solutions. We strive to recruit and retain only the finest health care professionals with the highest levels of integrity, compassion and competency. If you are driven by your own personal commitment to these values and desire to work in a team-focused, collaborative and supportive environment - while still being valued for your individual strengths - Health Choice is the place for you.

Equal Opportunity Employer Minorities/Women/Veterans/Disabled

Qualifications

Professional Competencies (knowledge, skills, and abilities):

* Microsoft Windows applications
* Knowledge of Medicaid and Medicare programs
* Knowledge of Commercial health plan programs
* Ability to plan and organize
* Strong customer service skills and techniques
* Strong presentation and oral and written communication skills
* Ability to negotiate and implement contracts

Education:
* Bachelor’s Degree preferred

Experience:
* Minimum five (5) years’ experience in healthcare environment. 
* A minimum of one (1) year contract negotiating experience preferred