Medical Network Manager
Purpose & Scope:
Ametros is looking for a confident and skilled Medical Network Manager that is driven to lead the charge on improving PPO Network relationships, establishing new processes, and communicate ongoing strategy with internal stakeholders. The ideal candidate will be a self-starter and an impeccable communicator. The Medical Network Manager will be responsible for the development, oversight, and performance of the Company's medical networks and management of PPO network partners with the goal of providing Ametros members effective and efficient medical care for the treatment of their related injuries. If you have knowledge surrounding the management of PPO Network Vendors and process, we would love to speak with you today.
- Manage doctor, hospital and specialty medical networks for the treatment of members.
- Ensure the networks and processes operate in compliance with Company policies, certification standards, and state and federal statutes and regulations.
- Maintain the highest level of expertise regarding workers compensation medical and group health networks including data analysis, current issues, future developments, best practices, contracting and contract management, certification standards, and legal requirements.
- Serve as the Company’s point of contact with networks and panels for outgoing and incoming communication regarding issues relating to their services including enrollment, membership, data, direction of care, network administration, and quality and cost of services; and actively work to resolve issues relating to these areas.
- Continually analyze data from vendors, providers, the industry, and the Company to increase the Company s capacity to understand the effectiveness and efficiency of providers and treatment methods.
- Participate in the selection of vendors and providers of network and panel services; participate in the creation and negotiation of contracts with them, including pricing terms; and manage those contractual services and obligations.
- Foster a positive and close working relationship with other Company staff, including the adjusting staff, utilization review, medical bill review, nursing services, special investigations, legal, lien resolution, the call center, and client services.
- Provide information and support regarding medical networks and panels in general and regarding issues arising from specific medical treatment to other Company staff.
- Provide oversight and analytics of selected providers within the Company s Medical Provider Networks. Work in tandem with Company s data analysts in creating and enhancing outcome measurements.
Experience, Education and Qualifications:
- Candidate must have BA or BS in Related field or equivalent industry work experience
- Candidate must have management responsibility experience of Provider Vendor Management Processes
- Candidate must understand and be able to work within all Federal and State guidelines when it comes to medical data management
- Knowledge of the Worker’s compensation claims process is not required, but strongly recommended for success in the role
- The ideal candidate will have worked in a claims processing capacity within the worker’s compensation field for 3 or more years
- The ideal candidate will have extensive knowledge in creating and maintaining Vendor agreements and performance standards.
The duties listed in this job description are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or a logical assignment to the position.