Partnership HealthPlan of California
Job Transportation Network Specialist
Partnership HealthPlan of California, Travis Afb, California, United States, 94535
Transportation Provider Network Manager
Establish and maintain excellent relationships with the transportation provider network. Identifies service gaps and recruits new transportation providers to increase network adequacy. Works closely to identify and resolve complex issues, provides education and staff training to transportation providers and healthcare providers with members experiencing transportation access issues. Assists providers with understanding Partnership HealthPlan of California's transportation-related policies and procedures and assists with resolving issues that arise. Responsibilities
Maintains regular schedule of transportation provider office visits to ensure open lines of communication, answers questions, distributes information, and documents and follows up on questions or concerns. Investigates and responds to transportation-related provider concerns, questions and resolves issues. Assists with research and disposition of provider appeals and grievances. Conduct transportation provider education opportunities in person, on-site, and/or via electronic media such as webinars, video conferencing, or other technology. Creates external educational materials and formal presentations. Conducts transportation provider orientations and ongoing educational training sessions. Educates providers on the use of Partnership provider information forms and reporting. Follows up with providers on incomplete forms to obtain required information. Resolve complex authorization or claims issues. Identify potential system issues, collaborate with affected departments to ensure resolution. Creates Corrective Action Plans (CAPS) for provider sites that did not meet standards. Monitors compliance with CAP. Conducts research to identify trends and provides recommendations for ongoing, long-term resolutions to issues. Conducts routine environmental scans to assess network adequacy and identify gaps and recruitment targets. Works in collaboration with Provider Contracting to contract and onboard new transportation providers. Coordinates, attends, and participates in various meetings both on and off-site as assigned. Prepares monthly transportation provider support card and ad hoc reports for leadership as necessary. Required to work with minimal supervision and maintain availability to transportation providers and transportation leadership after normal business hours when necessary to resolve issues. Maintains knowledge of NEMT, NMT and ancillary services policies and procedures and related state and federal guidelines. Other duties as assigned. Secondary Duties and Responsibilities May need to be available after normal business hours, as needed, to assist transportation providers and support leadership. Qualifications
Education and Experience Bachelor's degree in health care administration, business, or public relations preferred, or equivalent combination of education and experience; prior experience with physician offices or managed care or health insurance environment preferred. Special Skills, Licenses and Certifications Excellent oral and written communication and presentation skills. Excellent organizational, prioritizing, and multi-tasking skills required. Ability to use good judgment in making decisions within scope of authority and handle sensitive issues with tact and diplomacy. Proficient in Microsoft Office (Word, PowerPoint, Excel). Ability to use a variety of databases for research and entry of information. Valid California driver's license and proof of current automobile insurance compliant with Partnership policy are required to operate a vehicle and travel for company business. Performance Based Competencies Must be able to work in a fast-paced environment and maintain courtesy and composure. Ability to function effectively with frequent interruptions. Work Environment And Physical Demands At least 50% of work time is spent driving and more than 30% of work time is spent in front of a computer monitor. Ability to lift, carry or move objects of varying size, weighing up to 25 lbs. All HealthPlan employees are expected to: Provide the highest possible level of service to clients; Promote teamwork and cooperative effort among employees; Maintain safe practices; and Abide by the HealthPlan's policies and procedures, as they may from time to time be updated. HIRING RANGE: $72,364.92 - $90,456.15 IMPORTANT DISCLAIMER NOTICE The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.
Establish and maintain excellent relationships with the transportation provider network. Identifies service gaps and recruits new transportation providers to increase network adequacy. Works closely to identify and resolve complex issues, provides education and staff training to transportation providers and healthcare providers with members experiencing transportation access issues. Assists providers with understanding Partnership HealthPlan of California's transportation-related policies and procedures and assists with resolving issues that arise. Responsibilities
Maintains regular schedule of transportation provider office visits to ensure open lines of communication, answers questions, distributes information, and documents and follows up on questions or concerns. Investigates and responds to transportation-related provider concerns, questions and resolves issues. Assists with research and disposition of provider appeals and grievances. Conduct transportation provider education opportunities in person, on-site, and/or via electronic media such as webinars, video conferencing, or other technology. Creates external educational materials and formal presentations. Conducts transportation provider orientations and ongoing educational training sessions. Educates providers on the use of Partnership provider information forms and reporting. Follows up with providers on incomplete forms to obtain required information. Resolve complex authorization or claims issues. Identify potential system issues, collaborate with affected departments to ensure resolution. Creates Corrective Action Plans (CAPS) for provider sites that did not meet standards. Monitors compliance with CAP. Conducts research to identify trends and provides recommendations for ongoing, long-term resolutions to issues. Conducts routine environmental scans to assess network adequacy and identify gaps and recruitment targets. Works in collaboration with Provider Contracting to contract and onboard new transportation providers. Coordinates, attends, and participates in various meetings both on and off-site as assigned. Prepares monthly transportation provider support card and ad hoc reports for leadership as necessary. Required to work with minimal supervision and maintain availability to transportation providers and transportation leadership after normal business hours when necessary to resolve issues. Maintains knowledge of NEMT, NMT and ancillary services policies and procedures and related state and federal guidelines. Other duties as assigned. Secondary Duties and Responsibilities May need to be available after normal business hours, as needed, to assist transportation providers and support leadership. Qualifications
Education and Experience Bachelor's degree in health care administration, business, or public relations preferred, or equivalent combination of education and experience; prior experience with physician offices or managed care or health insurance environment preferred. Special Skills, Licenses and Certifications Excellent oral and written communication and presentation skills. Excellent organizational, prioritizing, and multi-tasking skills required. Ability to use good judgment in making decisions within scope of authority and handle sensitive issues with tact and diplomacy. Proficient in Microsoft Office (Word, PowerPoint, Excel). Ability to use a variety of databases for research and entry of information. Valid California driver's license and proof of current automobile insurance compliant with Partnership policy are required to operate a vehicle and travel for company business. Performance Based Competencies Must be able to work in a fast-paced environment and maintain courtesy and composure. Ability to function effectively with frequent interruptions. Work Environment And Physical Demands At least 50% of work time is spent driving and more than 30% of work time is spent in front of a computer monitor. Ability to lift, carry or move objects of varying size, weighing up to 25 lbs. All HealthPlan employees are expected to: Provide the highest possible level of service to clients; Promote teamwork and cooperative effort among employees; Maintain safe practices; and Abide by the HealthPlan's policies and procedures, as they may from time to time be updated. HIRING RANGE: $72,364.92 - $90,456.15 IMPORTANT DISCLAIMER NOTICE The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.