Job Abstract

The Advisor Provider Network is an out-of-the-box, critical thinker, who is able to execute consistently in daily operations. This position will serve as a strategic liaison between the Director, Provider Network (PNM), and Provider Network team.  This role is responsible for ensuring compliance with all regulatory and delivery of optimal operational activities, monitoring trends and timelines, and communication. The Advisor will act on behalf of the Director on operational activities and provide updates to ensure smooth communication. Plans and maintains work systems, procedures, and policies that enable and encourage the optimum performance of resources within Provider Network Operations.  The Advisor will also support varying initiatives to build a highly effective, motivated and functional workplace at L.A. Care.

Develop, maintain, and manage a standardized framework to monitor operational activities, trends and timelines, communication, and coordination of PNM Operations. Provide content-specific information for the Director to stay up to date on operational activities.

Develop and partner with the PNM department management to maintain reports and metrics that monitor compliance and regulatory requirements to drive achievement of engagement strategies. 

Oversight of all required internal and external regulatory reports.

Partner with the business leaders within PNM to communicate compliance and operational priorities and provide feedback or follow-ups to key staff members.

Establish Provider Business Analytics Team within CRM to streamline financial work-ups, Settlement Planning, and support ad hoc contract negotiations. 

Attend internal and external meetings.

Perform other duties as assigned. 

Required:
At least 6 years of experience in contracting and/or regulatory analysis in managed care or healthcare industry. 

Experience managing work streams, including monitoring for project issues and sound judgement for escalation. 

Experience leading projects and ensuring timelines are met.

Experience working with a diverse group of people, including physicians, support staff, coworkers and management.

Experience with researching issues and bring about resolution either directly or with the assistance of others

Required:
Demonstration of both qualitative and quantitative analytical skills.

Proven ability to work with a diverse group of people, including Executive and Senior Leadership within and outside of L.A. Care, support staff, and coworkers.

Demonstrated ability to research issues and bring about resolution either directly or with the assistance of others.

Demonstrated critical thinking and problem solving skills.

Excellent written and verbal communication skills.

Strong elicitation and process documentation skills.

Strong organizational and communication skills to build and foster effective relationships with the ability to influence and direct operational activities.

Must possess a robust knowledge of all contracted PNM entities, including provider groups (PPG’s), Management Service Organizations (MSO’s), Vendors, Subcontractors, and directly contracted practitioners.

Strong critical thinking and problem solving skills to help ensure successful partnerships and department quality.

Proficiency with Microsoft Office tools including Word,  Excel, Power Point, Access.