Provider Network Manager

Detroit Wayne Integrated Health Network • Detroit, MI • 2h ago

Under the supervision of the Director of Managed Care Operations, the Provider Network Manager is responsible for the overall coordination of the contracts between the Detroit Wayne Integrated Health Network (DWIHN) and the assigned network providers.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

Manages the contracts between (DWIHN) and the assigned network providers.

Serves as the primary liaison between the Network and the providers.

Leads a "virtual team" of interdepartmental experts to assist, monitor and manage the network providers

Collaborates with Finance, Information Technology, Recipient Rights, Quality Management, and Clinical Services to ensure that all contractual issues/concerns are addressed.

Serves as the providers primary point of contact with the Network.

Facilitates the successful implementation of new contracts with providers by providing technical assistance.

Monitors, assesses and ensures that providers receive required and necessary training.

Protects the confidential and proprietary nature of provider operations.

Explains and interprets the Network's policies, procedures and goals to the provider network.

Resolves problems; responds to issues, requests and complaints; and answers questions for the provider network.

Collaborates with other Contract Managers to propose revisions to the Network's policies and procedures to improve interface with network providers.

Obtains and disseminates required provider network data for network development and maintenance.

Participates in the analysis of network provider performance data to ensure appropriate network utilization and identify needs for network modification and reconfiguration.

Facilitates provider network compliance and corrective action.

Responds to general public inquiries, problems and concerns.

Maintains documentation of all interactions with the provider network.

Submits monthly and quarterly written reports regarding provider network performance and progress.

Facilitates monthly/quarterly meetings with the provider network.

Prepares Board Actions as needed.

Monitors the contracting process from board action to approval.

Maintains oversight of the contracting process with network providers to ensure compliance with all procurement requirements.

Performs related duties as assigned.

KNOWLEDGES, SKILLS AND ABILITIES (KSA'S)

*

Knowledge of DWIHN policies, procedures and practices.

Knowledge of the DWIHN provider network and community resources.

Knowledge of the Michigan Mental Health Code.

Knowledge of MDHHS policies, rules, regulations and procedures.

Knowledge of Federal policies, rules, regulations and procedures as it relates to DWIHN.

Knowledge of compliance standards.

Knowledge of regulatory and industry best practice standards.

Knowledge of Community Mental Health Services Programs (CMHSP) and Prepaid Inpatient Health Plans (PIHP).

Management skills.

Training skills.

People management skills.

Project management

Action planning skills.

Conflict Resolution skills

Corrective Action skills.

Assessment skills.

Organizational skills.

Planning skills.

Accuracy skills.

Analytical skills.

Time Management skills.

Report writing skills.

Negotiation skills.

Interpersonal skills.

Communication skills.

Collaboration skill

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