Manager - Health Plan Provider Network
at Adventist Health System

Date Posted: 4/10/2017

Job Description

Job:  Human Resources

Organization:  Adventist Health System Corporate Office

Shift:  Day

Job Posting:  Jan 26, 2017, 9:14:30 AM

If you want to be a part of a place that provides nothing less than extraordinary compassionate care, then Adventist Health System is the place for you!
We are currently seeking qualified candidates for a Manager Health Plan Provider Network position that will be based in our Human Resources department. This position is based at our corporate office in Altamonte Springs, FL.  
This position provides the opportunity to assists the Director of Employee Benefits in administering aspects of the AHS Health Plan and related benefits, with an emphasis on ensuring the adequacy of the provider network for the AHS Employee Health Plan. The Manager of Health Plan Provider Network will be responsible for ensuring network adequacy, communication and reporting in support of health benefit strategies and related corporate strategic goals. The position works collaboratively with organizational business and operational units (PHSO, FHHS and Facility HR Business Partners) to ensure that the Health Plan is supported by an adequate provider network that meets the needs of the member population. The Manager of Health Plan Provider Network applies analytical and creative abilities to formulate solutions to complex issues, researching, developing/implementing resolutions and improvements to current practices as needed. The Manager also assists with other employee benefit projects and initiatives as directed.
Specific job duties include:
Maintain Health Plan Network Adequacy (80%):
  • Conduct audits of network adequacy for each hospital service area in order to maintain member access at desired levels.
  • Collaborate departmentally and cross-organizationally in the development and planning of provider network needs.
  • Evaluates utilization of the network, specifically Tier 1 providers, to help minimize outflow of dollars through the AHS Health Plan to competing or non-strategically aligned providers.
  • Insure that network providers are correctly identified and loaded in to the Third Party Administrator database(s) and that operational issues or errors are quickly corrected.
  • Identify and implement opportunities to communicate with key network providers regarding the AHS Health Plan.
  • Represent the AHS Health Plan in appropriate internal and external committees and meetings.
  • Serve as the Subject Matter Expert for communication/education of internal and external audiences in the area of responsibility.
  • Monitor health plan trends in general and within the industry to insure our health plan design remains competitive in terms of providers and covered services.
  • Help identify and implement medical expense savings opportunities particularly within the area of responsibility.
  • Assist with the development and communication of the AHS health benefit network philosophy.
COE Related Activities and Special Projects (20%):
  • Assists the Director with benefit vendor management issues
  • Assists in the development of the vision and strategy for the department and assigned functions
  • Facilitates the successful completion of special projects as needed
Experience Requirements:
  • Minimum 4 years of experience with a managed care organization or a health care related organization
  • Demonstrated understanding and experience in provider contracting, financial analysis, data analysis, contract implementation and maintenance of contractual agreements
  • Comprehensive knowledge of provider reimbursement mechanisms
  • Comprehensive knowledge of health insurance; insurance laws and regulations, including claims processing; medical and insurance terminology and procedure and diagnostic codes
  • Experience building and managing health plan provider networks
  • Has knowledge of reports needed and can obtain or develop them
  • Demonstrated experience with managing and cultivating strong business relationships
Educational Requirements:
  • Bachelor’s degree specializing in Health Administration, Business Administration, Human Resources and/or Employee Benefits required
  • A Master’s Degree in a related field preferred
Knowledge and Skills Required:
  • Thorough understanding of Health Plan administration and provider network development
  • Experience in a managed healthcare or hospital environment
  • Has an in depth knowledge of Health Plan related laws and regulations
  • Ability to communicate with, and educate others
  • Detail oriented, with strong proofreading and editing skills
  • Self-motivated, with flexibility to multitask and prioritize in a rapidly changing environment
  • Ability to resolve issues with minimal direction or guidance, as well as work independently and as a team member
  • Adapt to changing and multiple deadlines, managing day-to-day workflow
  • Supports AHS culture and values
  • Proficient in MS Office products including Outlook, Word, Excel and PowerPoint
  • Must be able to operate office equipment including personal computer, scanners, fax machines, printers and copy machines
If this position sounds like a great match for your skills set and experience, please apply online now!

Job Snapshot

About Us

About Adventist Health System

Who We Are

We are one of the largest faith-based health care providers in the United States. For 150 years, we have carried on a tradition of providing whole-person care that not only addresses patients' physical ailments, but also supports their emotional and spiritual well-being. We demonstrate the same level of compassion and care for our employees as well, doing all that we can to help them realize their full potential – both personally and professionally.

Who You Are

You are a compassionate, talented professional who wants to work in an environment where you can live out your faith and your values. You are excited about being part of a team that uses the latest technology and medical research to ensure patients receive quality care, but who also recognize that great care is always personal. You enjoy going out of your way to make each patient and their family feel special, and are passionate about guiding them toward optimal health.

Our Community

Our community is global and so is our reach. From coordinating medical mission trips in Ethiopia to planting school gardens in Florida, we are constantly seeking ways to go beyond hospital walls in improving the health of our communities. As a member of our team, you will be encouraged to use your talents in fun, meaningful ways that bring joy and healing to people around the world.

Our Mission

Part of this worldwide network, Adventist Health System was founded in 1973 to support and strengthen the Seventh-day Adventist health care organizations in the Southern and Southwestern regions of the United States. Today it is a national leader in quality, safety and patient satisfaction, comprised of 46 hospital campuses and nearly 77,000 employees.

Although separated by geography, each of our facilities is united by the mission of Extending the Healing Ministry of Christ. Today we continue the tradition of whole-person care by practicing and sharing CREATION Health, a blueprint for living a healthy, happy life based on the principles given in the Bible’s creation story: Choice, Rest, Environment, Activity, Trust, Interpersonal relationships, Outlook and Nutrition.

We provide comprehensive benefits, training and advancement opportunities. We care for our employees as well as we care for our patients.