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Provider Network Manager

Company: Western Dental Services
Location: Bakersfield
Posted on: March 18, 2023

Job Description:

Responsible for assigned local and out of state dental plan processes and activities necessary to develop and maintain the provider network and financing system. Responsible for project management, metrics and internal communication to Operation departments. Team lead and subject matter expert. Position will require field work in Northern California.Job Responsibilities / DutiesDevelop and maintain a competitive network of providersMeet Health Care cost outlined for targeted assigned territoriesSupport marketing, sales and client activities as neededEnsure network providers understand and adhere to company goals and initiatives set forth in the Policies and ProceduresEnsure network providers and staff understand DHMC regulations and guidelinesSupport the Quality Management Program by monitoring provider compliance and quality.Projects deadlines and success ratio metProvider Relations staff quarterly recruitment goals are efficiently monitored and evaluated.Effective teamwork and collaborationCommunications with all Operational Departments are effective and goals are met.Developing and maintaining the provider networkTrain provider network staff in OSHA compliance and assist in correcting deficienciesContracting providers within the targeted reimbursement levelsResponsible for successfully negotiating lower provider compensations models to meet targeted PMPM levels.Manage assigned projects to a success conclusionAnalyze annual goals and team's ability to meet goals and deadlines on a quarterly basisWork closely with internal departments to identify the need for Provider Relations temporary and permanent intervention.Responsible for Provider Relations Policies and ProceduresResponsible for Department MetricsProvide subject matter expertise and advise as requestedTeam LeadStrong negotiation and reasoning skillsThorough knowledge of managed dental care:Reimbursement mechanismsQuality improvement initiativesAbility to create and present solutions to specific problemsThorough knowledge of government agency fee for services and managed care dental plans.Ability to manage multiple projectsMeet goalsMeet timelinesAbility to conduct trainings to small and large groupsExperience working with Account Executives and the ability to present products to Brokers in a formal and in-formal environmentBachelor DegreeMinimum of 10 years' experience in dental managed care, dental insurance industry or dental providerTravel 90%CADP Auditor preferredTo apply please email:

Keywords: Western Dental Services, Bakersfield , Provider Network Manager, Executive , Bakersfield, California

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