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Manager, Client Network Management / Central CA (Fresno County)

Job ID: 2105042631 Date posted: 11/10/2021 Facility: Conifer Health Solutions
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Job Details

JOB SUMMARY

Accountable for the client relationship and financial performance, which may include, but not limited to increase membership year over year, maximize client capitation revenue and manage client medical spend, coordinate the client team to ensure that client issues are resolved timely. Responsible to realize and achieve the assigned client revenue, contract, and quality program targets.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

Accountable and responsible for achieving and delivering on the client strategic growth and financial (revenue) performance targets. Responsible for client membership and provider growth. Accountable for the timely and accurate implementation of the delegated services to the client and escalation path when barriers, obstacles, and/or challenges may result in missed deliverables. Responsible for identification of issues and provide workable solutions and/or options to ensure client performance and/or objectives are met.

Maintain provider network adequacy for client and ensure compliance with SB 137. Manage and track client issues and coordinate with operational teams to address and resolve client issues. Participate in the CVBC Quality Improvement committee and programs and work with the provider networks to close gaps in care, improve quality measures, and encounter data submissions, and other quality program domains, such as, access and availability and satisfaction surveys scores. Prepare and gather materials to comply with payor health provider network audits.

Prepare and conduct monthly executive board and partner joint operation meetings, review financial statements, including profit and loss, balance sheet, IBNR analysis, analyze utilization trends, make board recommendations, track action items, and maintain tracking logs and minutes. Maintain high level of client executive engagement to ensure client referenceability.

Accountable for existing client growth targets are achieved and new services/upsell opportunities are realized, including but not limited, adherence to the change control notice (CCN) and deal review committee processes (DRC I and II). Serve as subject matter expert for new client logos.

Work with operational and functional department teams to ensure that client business objectives are executed on time.

SUPERVISORY RESPONSIBILITIES

This position reports to the Senior Director, West Region Provider Practice and requires moderate degree of supervision to ensure strategic initiatives and client expectations are prioritized, met, and successfully implemented.



Qualifications:

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

KNOWLEDGE, SKILLS, ABILITIES

Candidates that exhibit most of the following preferred qualifications will be well suited for this position. However,

  • 2-4 years of health plan or management service organization experience in managing risk bearing organizations or related area
  • 2+ years in managed care experience preferred
  • General working knowledge of the risk bearing organization and the delegated UM, Credentialing, Network Management, Customer Service, Finance, and Case Management funtions.
  • General working knowledge of risk bearing operating and performance revenue and expense levers
  • General working knowledge of payor strategies and market layout.

EDUCATION / EXPERIENCE

Bachelor Degree or higher

REQUIRED CERTIFICATIONS/LICENSURE

  • No

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • Must be able to work in a sitting position, use a computer and answer telephone
  • Light physical effort (lift to 10 lbs.).
  • The home office for this position will be located in Encino, CA.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • Office Work Environment
  • Hospital Work Environment
Job: Conifer Health Solutions
Primary Location: Encino, California
Job Type: Full-time
Shift Type: Days

Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Tenet participates in the E-Verify program. Follow the link below for additional information.

E-Verify: http://www.uscis.gov/e-verify

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