Network Management Implementation Specialist

This is a fully remote position, open to applicants in California.

📋 Description

• Oversee comprehensive provider onboarding and offboarding management: Lead all cross-functional tasks and deliverables related to provider onboarding, including pre-delegation audits, roster loading and display, MFT setup, claims payment configuration, and reporting activation to ensure a smooth onboarding process.

• Supervise provider offboarding procedures: Ensure a seamless transition when a provider ends or changes MSO affiliation by coordinating member reassignment, removing provider data, deactivating reports, and ensuring compliant communication with members in collaboration with internal teams.

• Create and maintain workflows and documentation: Design, execute, and regularly refresh standardized workflows, procedures, and timelines to uphold consistent practices, operational readiness, and data integrity throughout the provider lifecycle.

• Ensure effective operational transitions across departments and compliance with established timelines for onboarding and offboarding tasks.

• Collaborate with Network Training and Compliance teams: Work alongside the Network Training Specialist for educational and training requirements and coordinate with the Compliance team to ensure all policies, desktop procedures, and materials related to provider onboarding and offboarding meet regulatory and organizational standards.

• Monitor project milestones and manage risks: Track and evaluate project deliverables, identify potential risks or process gaps, and coordinate timely solutions with business partners to uphold accuracy and efficiency in operational readiness for provider onboarding and offboarding.

• Act as a subject matter expert and liaison: Represent Network Management in cross-functional meetings and governance committees regarding provider onboarding and offboarding, offering insights and expertise on provider implementation, configuration readiness, and operational enhancement.

• Ensure compliance and audit readiness: Foster adherence to CMS, DMHC, DHCS, and NCQA regulations through precise documentation, lifecycle tracking, and post-termination data closure activities to maintain audit readiness and meet quality standards.

• Facilitate provider communications, education, and presentations: Partner with Network Training and Communications teams to improve provider onboarding materials, orientation tools, and outreach initiatives to boost provider understanding and engagement.

• Conduct provider presentations and engage directly with provider partners to clarify onboarding expectations, operational workflows, and ongoing requirements.

• Promote continuous process improvement: Identify and implement enhancements to workflows, tools, templates, and reporting processes that enhance efficiency, accuracy, and provider satisfaction throughout the lifecycle.

• Assist in system modernization and integration initiatives: Participate in SCAN’s system enhancement and migration projects by gathering business requirements, testing improvements, validating changes, and supporting implementation during and after release.

⛳️ Requirements

• 3-5 years of experience in provider network management, healthcare operations, or implementation roles that necessitate cross-functional collaboration, process coordination, and strong communication abilities.

• A minimum of 3 years of experience in provider onboarding and direct provider engagement, including delivering presentations and facilitating discussions on operational workflows, onboarding expectations, and compliance requirements.

• A solid understanding of Medicare Advantage operations and provider-facing processes is essential.

• A Bachelor's Degree or equivalent experience is required.

• A Graduate or Advanced Degree or equivalent experience is preferred.

• Proficient in Microsoft Office (Word, Excel, Outlook, Teams, PowerPoint, Visio).

🏝️ Benefits

• An annual employee bonus program

• Robust Wellness Program

• Generous paid-time-off (PTO)

• Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday

• Excellent 401(k) Retirement Saving Plan with employer match and contribution

• Robust employee recognition program

• Tuition reimbursement