Sharp HealthCare
Network Management Specialist - SCMG Provider Services - Sharp Corporate - Day Shift - Full Time
San Diego, CA
Mar 9, 2025
Full Job Description

Hours:

Shift Start Time:

8 AM

Shift End Time:

5 PM

AWS Hours Requirement:

8/40 - 8 Hour Shift

Additional Shift Information:

Weekend Requirements:

As Needed

On-Call Required:

No

Hourly Pay Range (Minimum - Midpoint - Maximum):

$33.090 - $42.700 - $52.310


The stated pay scale reflects the range that Sharp reasonably expects to pay for this position. The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant's years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.



What You Will Do
Professionally manages all aspects of an assigned SCMG provider region. Works closely with the physician network, affiliated hospitals, ancillary providers, Sharp HealthCare and all departments within SCMG. Specifically, recruit, orient and provide ongoing service to providers and ensure provider adherence to policies and procedures of SCMG and affiliated health plans. Identifies and resolves providers issues or concerns in a timely manner. Consistently supports SCMG by maintaining a positive and professional image.

Required Qualifications

  • Associate's Degree Related field (equivalent from two year college or technical school may substitute)
  • 5 Years IPA or related experience with excellent organizational, oral/written communication skills, and interpersonal skills.


Essential Functions

  • Actively promotes improved relationships
    Responsible for maintaining and enhancing relationships with Providers (including ancillary) and office staff.
  • Assist with development of marketing and public relations materials as requested for SCMG and its providers, affiliated health plans, hospitals, or consulting groups, such as newsletters or photographs of physicians
  • Business development
    Develop relationships with community businesses (i.e. Senior Centers, Assisted Living Homes, Marketing Consulting Groups, etc) and coordinate lectures, screenings, and other marketing events with that business
  • Collaboration and teamwork
    Oversees activities and coordinates projects with other persons within the Network Management Department to provide education and communicate information to the provider network. (i.e. Regional Council Meetings, PCP council, Office Manager Meetings, Joint Operation Committee Meetings, etc.).
  • Community outreach activities
    Participate in health fairs, lectures, community events, and other marketing events to promote IPA and it's affiliated providers.
  • Data collection and distribution
    Responsible for producing, updating, and distributing information to provider network, including patient satisfaction reports, Pay for Performance initiatives and QISR.
  • General support
    Perform other functions as requested.
  • Health education
    Coordinate and provide assistance to health plans and other clients as necessary for health education services (i.e. participate in health fairs and member orientations as needed).
  • Information systems support
    Supports physicians and staff when implementing Information Technology in the provider offices. Able to demonstrate knowledge of hardware specifications and software applications. Installs, trains and maintains necessary applications in provider offices. Acts as liaison between Sharp IS and provider office.
  • Meeting participation
    Attend meetings as needed to provide information about IPA's policies & procedures and operations or as a departmental representative. Responsible for agenda preparation and content; records meeting minutes.
  • Physician contracts
    Ability to review, negotiate and comprehend physician contracts in order to respond to inquires from physicians & staff. Conducts contract analysis related to contract performance by examining appropriate claims and other applicable data.
  • Problem resolution
    Act as a liaison to ensure timely problem/issue resolution between Health Plans, Hospitals, SCMG, and Providers. Accountable as a liaison between providers and SCMG departments for successful identification and resolution of issues.
  • Professional development
    Identify and participate in educational classes that will improve the relationship between SCMG and physician network.
  • Reports and surveys
    Coordinate the production and dissemination of necessary reports and surveys to effectively manage assigned region.
  • Training and education
    Responsible for conducting on and off-site training sessions for new and existing Providers and office staff. This includes but is not limited to education regarding contract interpretation, claims, coding, operations, reimbursement, compliance issues, clinical operations, policy and procedures, governmental regulation and technology solutions, i.e., HIPPA, AB1455 and Pay for Performance.


Knowledge, Skills, and Abilities

  • Ability to read and analyze, and interpret contracts, general business periodicals, professional journals, technical procedures, or governmental regulations.
  • Ability to understand computer hardware and software applications.
  • Ability to write reports, business correspondence, and procedure manuals.
  • Ability to effectively present information and respond to questions from groups of managers, providers and the general public.
  • Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
  • Able to demonstrate specific technical knowledge related to LAN/WAN configurations and multiple practice management systems.
  • Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
  • Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
  • Must be proficient in Microsoft Office and Internet technologies.
  • Must also be detail-oriented and be able to speak in front of large groups, audience can range from 1 to 150 individuals.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class

PDN-9e632fe0-ec11-4b51-97e5-c710297373ec
Job Information
Job Category:
Healthcare Services
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Network Management Specialist - SCMG Provider Services - Sharp Corporate - Day Shift - Full Time
Sharp HealthCare
San Diego, CA
Mar 9, 2025
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