This is budgeted position that has Profit and Loss accountability for two independent practice associations (IPAs) under the PrimeCare Medical Network managed by NAMM - there are 200 primary care and specialty providers. The IPA Operations Manager has direct accountability for developing and executing business plans that will maximize the performance of IPA(s) assigned, executing on IOI improvement plans for 2019 and for advancing the overall performance of the provider network. Additionally, this individual is accountable for provider experience, negotiating professional contracts (e.g. unit cost), managing strategic relationships with key provider organizations, and executing on organic growth and business development initiatives.
Under the direction of the AVP Network Operations, provides operational support services for the IPA(s) business needs to achieve defined goals. Provides operational oversight of network staff and recommends action for all shared services. Responsible for functioning as a direct representative for the organization with members and providers.
Interfaces with the IPA physicians to ensure member and provider satisfaction and network integrity/stability. Acts to resolve concerns in accordance for corporate guidelines and standards for all areas of claims, authorizations and IPA functionality
- Responsible for provider services functions in the local market place. Representing the organization and functioning as a key member of the local field market by having regular face to face interaction with the local providers and proactively providing a superior customer experience
- Subject to the approval of the AVP Network Operations, directs all provider contracting and provider relation activities in support the IPA(s)
- Coordinates, monitors and takes appropriate action as needed to ensure quality of all services provided in support of the IPA(s) goals and objectives
- Responsible for ensuring network compliance with regulatory standards and contractual requirements including but not limited to accessibility and availability of required providers
- Responsible for implementation of IPA(s) strategic plan with network staff. Plan and organize workload of IPA staff to ensure efficient and timely resolution of issues
- Responsible for working the designated health plans, hospitals, and other network partners on local issues and concerns and coordinate with contracts representative for directory accuracy under the direction of the Executive Director
- 2+ years Supervisory experience with Direct Reports including management of workflow
- 3+ years experience in the Managed Healthcare field
- 1+ years experience with Contract Negotiations
- Intermediate experience with Word, Excel, and PowerPoint
Profit/Loss Statement Management experience
- Network Development experience
- Experience developing and executing business plans
- Broad based background in health care and medical management
- Experience working collaboratively effectively with all levels of employees, management, and stakeholders
Careers with Optum. Here s the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life s best work.(sm)
North American Medical Management, California, Inc. (NAMM) develops and manages clinician networks, offering a full range of services to assist physicians and other clinicians in their managed care and business operations. For over 17 years, NAMM has been an innovator in health care with a track record for quality, financial stability, extraordinary services and superior electronic capabilities. Prime Care Medical Network is a key affiliate.
OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCares support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.