Manager of Provider Network Management

Position Overview

The Manager of Provider Network Management is responsible to ensure CBH s provider network has adequate service delivery capacity to support timely and effective access to behavioral health services and meet network adequacy standards.

Essential Functions

• Functions as a liaison between departments to ensure network adequacy, efficiency and effectiveness.
• Conduct ongoing network analysis, monitoring network against the member demographics, utilization and other targeted population indicators.
• Provide leadership in evaluating opportunities to expand or change the provider network to meet CBH members behavioral health needs.
• Oversee the development and implementation of all procurements (RFP/Q/A/I) for clinical service enhancements and expansions.
• Perform data analysis and develop specific action plans to monitor utilization trends.
• Responsible for compliance with HealthChoices network adequacy standards.
• Work with the relevant departments to understand service gaps and opportunities for improvement with existing network providers.
• Establish internal standards for the development and maintenance of the provider network to ensure adequacy and accessibility of contracted services.
• Coordinate the execution of complex projects.
• Provide supervision to assigned staff, write and review annual performance evaluations and ongoing monitoring of staff performance.
• Perform other related duties and projects as assigned.
• Ability to travel and work nontraditional work hours when necessary.

Position Requirements

• Education: Master s degree in Behavioral Health, Public Health, or related Healthcare field.
• License/Certification: N/A
• Relevant Work Experience: Minimum of three years of direct experience working in a managed care environment with at least one year of experience working with Medicaid programs.

Skills

• Strong knowledge of the Pennsylvania Medicaid program
• Excellent strategic, analytic, problem solving
• Comfortable with ambiguity and able to set your own direction
• Ability to work independently and as part of a team
• Skilled in working with data sets
• Strong project management and organizational skills
• Effectively work in a fast-paced environment with frequently changing priorities and deadlines Strong time management skills to meet established deadlines and handle multiple project demands
• Effectively communicate and build strong relationships with internal and external stakeholders
• Strong written and verbal communication skills
• Excellent active listening and critical thinking skills
• Ability to maintain confidentiality and appropriately share information on a need to know basis
• Ability to consistently deliver excellent customer service
• Ability to define problems, collect data, establish facts, and draw valid conclusions
• Excellent attention to detail and ability to document information accurately
• Demonstrated experience in a supervisory or leadership role
• Intermediate proficiency in Microsoft Outlook, Word, Excel and PowerPoint Knowledge of and/or ability to utilize software applications
• Ability to quickly learn and use new software tools

Philadelphia Residency Requirement

• The successful candidate must be a city of Philadelphia resident within six months of hire

Covid-19 Vaccine Requirement

• Please note that effective September 1, 2021 the City of Philadelphia is requiring all new employees to present proof of vaccination against COVID-19.

Equal Employment Opportunity: Community Behavioral Health (CBH) provides equal employment opportunities to all qualified individuals without regard to race, creed, color, religion, national origin, age, sex, marital status, gender identity, sexual orientation, individual genetic information or non-disqualifying physical or mental handicap or disability in each aspect of the human resources function.

Americans with Disabilities Act: Applicants as well as employers who are or become disabled must be able to perform the essential job functions either unaided or with reasonable accommodation. The organization shall determine reasonable accommodation on a case-by-case in accordance with applicable law.