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Provider Network Manager

Location: Orange
Posted on: July 15, 2019

Job Description:

Requisition Number 19-1419 Title Provider Network Manager City Orange State CA Zip Code 92868 DescriptionResponsible 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.

Job Responsibilities / Duties

  • Develop and maintain a competitive network of providers
  • Meet Health Care cost outlined for targeted assigned territories
  • Support marketing, sales and client activities as needed
  • Ensure network providers understand and adhere to company goals and initiatives set forth in the Policies and Procedures
  • Ensure network providers and staff understand DHMC regulations and guidelines
  • Support the Quality Management Program by monitoring provider compliance and quality.
  • Projects deadlines and success ratio met
  • Provider Relations staff quarterly recruitment goals are efficiently monitored and evaluated.
  • Effective teamwork and collaboration
  • Communications with all Operational Departments are effective and goals are met.
  • Developing and maintaining the provider network
  • Train provider network staff in OSHA compliance and assist in correcting deficiencies
  • Contracting providers within the targeted reimbursement levels
  • Responsible for successfully negotiating lower provider compensations models to meet targeted PMPM levels.
  • Manage assigned projects to a success conclusion
  • Analyze annual goals and team's ability to meet goals and deadlines on a quarterly basis
  • Work closely with internal departments to identify the need for Provider Relations temporary and permanent intervention.

  • Responsible for Provider Relations Policies and Procedures
  • Responsible for Department Metrics
  • Provide subject matter expertise and advise as requested
  • Team Lead


    • Strong negotiation and reasoning skills
    • Thorough knowledge of managed dental care:

      • Reimbursement mechanisms
      • Quality improvement initiatives
      • Ability to create and present solutions to specific problems
      • Thorough knowledge of government agency fee for services and managed care dental plans.
      • Ability to manage multiple projects

        • Meet goals
        • Meet timelines
        • Ability to conduct trainings to small and large groups
        • Experience working with Account Executives and the ability to present products to Brokers in a formal and in-formal environment
        • Bachelor Degree
        • Minimum of 10 years' experience in dental managed care, dental insurance industry or dental provider
        • Travel 90%
        • CADP Auditor preferred

Keywords: WESTERN DENTAL SERVICES, Orange , Provider Network Manager, Executive , Orange, California

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