HCA, Hospital Corporation of America Manager of Network Management and Member Services in Foster City, California

Pacific Partners Management Services (PPMSI) is a managed services organization formed in 1997 with administrative offices located in Foster City, CA. We provide services to IPAs in the Santa Clara and Monterey Bay areas. Our managed care and ACO services support approximately 1,000 independent physicians and include executive management, full financial services, utilization management, quality improvement, credentialing, contracting, claims processing and provider and member network services.

PPMSI is part of HCA Physician Services Group (PSG), the physician and practice management solution for the Hospital Corporation of America (HCA). PSG operates more than 1000 practices, Urgent Care Facilities, and partners with HCA’s over 174 hospitals to structure employed provider programs, professional service agreements, and joint ventures that offer the communities we serve high quality, cost effective care. We manage a collection of highly motivated and innovative leaders who are committed to excellence in every aspect of their career.

We offer an excellent benefits package, competitive salary and growth opportunities. Join our team and share your skills and talents with the nation’s largest private provider of healthcare services.

Summary of responsibilities: Reporting to the Vice President of Operations, theManager of Network Management and Member Servicesis responsible for overseeing the operational activities of the Network Management and Member Services departments.

DUTIES AND ESSENTIAL JOB FUNCTIONS

Network Management 1. Supervises a staff consisting of Network Management Associates both in house and remotely, and a Network Management Coordinator whose primary function is to provide provider support/education and interaction with contracted Health Plans (HMO and PPO).

  1. Responsible for managing network provider education of applicable policies and procedures.

  2. Responsible for supervising daily provider inquiries, including capitation and reimbursement issues.

  3. Assist in development of physician communication programs and strategy.

  4. Responsible for maintaining strong relationships with contracted Health Plans (HMO and PPO).

  5. Communicates with payors and network providers, both orally and written, in association with operational and contractual related issues.

  6. Oversees client related projects.

  7. Assist in identifying issues, problems, and areas where performance could be improved.

  8. Represent PPMSI at physicians’ offices, contracted health plans, and committees when necessary.

    1. Develop and present educational pieces at network provider meetings.

    2. Primary responsibility for periodic statistical performance reporting of Network Mgt activities.

    3. Insure adequate physician network retention, expansion and recruitment.

    4. Assist with the development of strategic plans for servicing network physicians and members.

    5. Develop, recommend, and implement new policies and procedures when appropriate.

    6. Play a key supportive role in Quality Initiatives.

    7. In conjunction with the Vice President of Operations, provides supervisory assistance to the Network Management Contract Specialist and Credentialing Specialist.

    Member Services

    1. Supervise member services staff whose primary functions are to answer member telephone calls and correspondence, research issues and respond to member and provider inquiries and concerns.

    2. Insures that member and provider telephone calls are answered within performance standards, following departmental procedures.

    3. Manages resolution of provider and member issues with Network Management, Medical Management and Claims departments.

    4. Insures that caller logs are maintained in the computer system.

    5. Primary responsibility for periodic statistical performance reporting of Member Services activities.

    6. Conducts member/provider satisfaction surveys as instructed.

    QUALIFICATIONS:

  9. Bachelor’s degree in business, health care or related field, or equivalent experience.

  10. 4-5 years in health care setting, including progressively more responsible experience in a physician office management or physician relations capacity.

  11. 1-2 years of experience as a manager or supervisor of a department staff.

  12. Advanced knowledge of managed care market, strategies, and physician compensation models.

  13. Working knowledge of medical group/IPA operations.

  14. Excellent verbal and written communication skills.

  15. Excellent public speaking and interpersonal skills.

  16. Able to present oneself professionally and have the ability to address large groups of people in educational forums

  17. Strong research and analytical skills.

    1. Able to research complex contractual documents for interpretive purpose and utilize critical thinking skills.

    2. Efficient in Word, Excel, Power Point, and Visio.

Job: *Directors & Managers

Title: Manager of Network Management and Member Services

Location: California-Foster City-PPMSI

Requisition ID: 24614-73139