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Network Management Specialist
at Blue Shield of California in California
Helping make high-quality health care for Californians easy, accessible and affordable is a great calling. Knowing that your company has contributed over $125 million back into California communities and will continue to do so is flat out uplifting. Join the hardest working, not-for-profit health plan in California and be part of the solution.
Blue Shield of California (BSC) is seeking a Network Management Specialist for our Network Management Team in our El Dorado Hills office.
The Network Management Specialist will play a central role in managing Blue Shield’s state-wide behavioral health provider network. This position provides the unique opportunity to be involved with strategic departments across the organization and to be responsible for vital aspects of network and contract management.
This individual will be a key member of the Specialty Networks and Vendor Management Team in Network Management. This team is responsible for contracting with individual and statewide providers to complement our hospital and physician networks. The position will manage our directly contracted Behavioral Health network.
Job Responsibilities:
Develops, negotiates, implements and maintains a comprehensive statewide behavioral health provider network. This includes the development of payment policies, fee schedules, provider communications, and retention strategies, as well as the management of online directories.
Works with other team members to meet member and provider service requirements, including problem resolution. Identifies and addresses service issues across departments, develops process improvements, modifications and enhancements, and maintains ongoing cross-functional communications.
Supports MHSA (Mental Health Service Administrator) vendor management including delegation oversight, ongoing measurement of performance standards, network access and availability, compliance with BSC policies and procedures, and general regulatory, accreditation, and BCBS Association compliance.
Analyzes monthly claims paid data and develops standard utilization and cost reports including trend analysis, variance from budget, and benchmarking.
Works with various departments, including Sales, Underwriting, and Product to develop competitive benefit plan designs and implement new program initiatives.
Provides cross functional internal education and training of behavioral health provider networks, benefits, regulations and related operations.
Job Requirements:
Bachelor's degree and three years related experience and/or training or equivalent combination of education and experience.
Thorough knowledge of the health care industry and managed care delivery systems.
Strong financial negotiating skills.
Blue Shield of California is an Equal Opportunity Employer.
How to apply: DO NOT use the Apply Online button. Please copy and paste the following link into your browser address bar:
http://blueshieldca.contacthr.com/20757996
Blue Shield of California (BSC) is seeking a Network Management Specialist for our Network Management Team in our El Dorado Hills office.
The Network Management Specialist will play a central role in managing Blue Shield’s state-wide behavioral health provider network. This position provides the unique opportunity to be involved with strategic departments across the organization and to be responsible for vital aspects of network and contract management.
This individual will be a key member of the Specialty Networks and Vendor Management Team in Network Management. This team is responsible for contracting with individual and statewide providers to complement our hospital and physician networks. The position will manage our directly contracted Behavioral Health network.
Job Responsibilities:
Develops, negotiates, implements and maintains a comprehensive statewide behavioral health provider network. This includes the development of payment policies, fee schedules, provider communications, and retention strategies, as well as the management of online directories.
Works with other team members to meet member and provider service requirements, including problem resolution. Identifies and addresses service issues across departments, develops process improvements, modifications and enhancements, and maintains ongoing cross-functional communications.
Supports MHSA (Mental Health Service Administrator) vendor management including delegation oversight, ongoing measurement of performance standards, network access and availability, compliance with BSC policies and procedures, and general regulatory, accreditation, and BCBS Association compliance.
Analyzes monthly claims paid data and develops standard utilization and cost reports including trend analysis, variance from budget, and benchmarking.
Works with various departments, including Sales, Underwriting, and Product to develop competitive benefit plan designs and implement new program initiatives.
Provides cross functional internal education and training of behavioral health provider networks, benefits, regulations and related operations.
Job Requirements:
Bachelor's degree and three years related experience and/or training or equivalent combination of education and experience.
Thorough knowledge of the health care industry and managed care delivery systems.
Strong financial negotiating skills.
Blue Shield of California is an Equal Opportunity Employer.
How to apply: DO NOT use the Apply Online button. Please copy and paste the following link into your browser address bar:
http://blueshieldca.contacthr.com/20757996
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