Director Provider Network Management Jobs (NOW HIRING)

Position Overview:

Provider Network Management Analyst is primarily responsible for supporting the Provider Network Access and Development and the Provider Contracting teams with data analysis to inform provider network adequacy, capacity and disparities and to address need areas to support timely and effective access to behavioral health services and meet network adequacy standards.

Essential Functions:

• Maintain thorough and complete knowledge of the CBH provider network, including as new initiatives are implemented.
• Conduct and create ongoing process for data analysis, reviewing the accuracy and integrity of data; monitoring the provider network against member demographics, utilization and other targeted population indicators.
• Create and conduct ongoing processes to monitor member utilization of in-network and out of network (OON) providers, and identify OON providers not being utilized by members
• Lead provider network analyses and create reports to evaluate service utilization, adequacy and accessibility
• Conduct ongoing research in relation to provider network management and offer recommendations to ensure alignment with the PA Department of Human Services’ Healthchoices Behavioral Health Program Standards and Requirements.
• Assist with updating annual Provider Network and Member Needs Assessments.
• Run reports as requested by regulatory bodies
• Liaise with Information Technology (IT) department and other relevant departments to complete data-oriented tasks.
• Gather and interpret data as well as offer recommendations for program/service proposals and need areas identified through Network Adequacy
• Review and prepare analysis for procurements, including relevant demographics, treatment utilization and related gaps for target populations
• Review and prepare analysis of the provider network, including maximum licensed capacity, current network capacity, and member need and access to services offered by CBH’s provider network
• Create protocol (in conjunction with the unit Manager) regarding how data will be obtained, evaluated and incorporated into Provider Network Management projects
• Work with Provider Network Management team members to ensure efficient workflow of procurement process
• Perform other related duties and projects as assigned.
• Ability to travel and work nontraditional work hours when necessary

Position Requirements:

• Education: Bachelor’s Degree in Healthcare Management, Public Health, or Analytical Field required. Master’s Degree preferred.
• License/Certification: N/A
• Relevant Work Experience: At least 3 years of direct experience working in a managed care environment with information systems, data analytics, and/or provider operations.

Skills:

• Knowledge of the Pennsylvania Medicaid program
• Strong data analytics experience
• Advanced critical thinking and analytical skills to interpret sometimes ambiguous requirements
• Encourage and promote active team process engagement and individual ownership
• Exceptional communication (verbal and written) skills
• Strong attention to detail to ensure quality and accuracy in deliverables
• Comfortable with ambiguity and able to set your own direction
• Must work well under pressure and be able to meet aggressive deadline
• Ability to manage and coordinate multiple projects and deadlines while meeting quality standards
• Intermediate proficiency in Microsoft Outlook, Word, Excel and PowerPoint
• Experience with Network Analysis software and reporting such as GeoAccess
• Experienced user of Microsoft Access and SQL programming
• Must have the ability to quickly learn and use new software tools

CBH is a dynamic organization dedicated to providing access to high-quality, accountable care to improve the health and mental wellness of our members. We proudly offer a robust compensation and benefits package, including:

• Family Planning, Fertility, Adoption Benefits
• 403B Retirement Plan
• PTO Days/Sick Days
• Wellness Program
• Employee Assistance Program
• Health, Dental, Vision Insurance
• Medical, Prescription Drug Insurance
• Tuition Reimbursement
• Commuter Benefits
• Flexible Spending

Philadelphia Residency Requirement:

• The successful candidate must be a current Philadelphia resident or become a resident within six months of hire.

U.S. Authorization Requirement:

• CBH does not provide sponsorship for applicants requiring future work authorization. All candidates must be legally authorized to work in the United States without requiring sponsorship now or in the future.

Equal Employment Opportunity:

• We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CBH is an equal opportunity employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on all qualified individuals. This is without regard to race, ethnicity, creed, color, religion, national origin, age, sex/gender, marital status, gender identity, sexual orientation, gender identity or expression, disability, protected veteran status, genetic information or any other characteristic protected individual genetic information, or non-disqualifying physical or mental handicap or disability in each aspect of the human resources function by applicable federal, state, or local law.

Requesting An Accommodation:

• CBH is committed to providing equal employment opportunities for individuals with disabilities or religious observance, including reasonable accommodation when needed. If you are hired by CBH and require an accommodation to perform the essential functions of your role, you will be asked to participate in our accommodation process. Accommodations made to facilitate the recruiting process are not a guarantee of future or continued accommodation once hired.
• If you would like to be considered for employment opportunities with CBH and have accommodation needs for a disability or religious observance, please send us an email at CBH.Recruitment@Phila.gov