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Manager of Network Management in Boston, MA at Beacon Health Options

Date Posted: 1/1/2019

Job Snapshot

Job Description


The Manager, Network Management, is responsible for credentialing, re-credentialing, provider relations, fee schedules, provider data maintenance and Single Case Agreements (SCAs) for MBHP providers and facilities. Responsible for integration of the team with Corporate Provider Relations, Provider Contracting, Credentialing and Provider Data teams. Responsible for standardization of credentialing processes using tools such as CAQH and automated sanctions monitoring. Drives consolidation to one credentialing process for Massachusetts providers. Manages various functions in multiple systems and platforms, oversees the work queues in the provider application, meeting or exceeding all established productivity and quality standards. This person will navigate Beacon’s matrix structure to engage, coordinate and support cross-functional Beacon stakeholders.

Position Responsibilities:

  • Effectively lead the Beacon MBHP Network Management team as evidenced by provider, internal customer and client satisfaction, compliance with internal, client, regulatory and accreditation standards, successful audits, employee satisfaction and engagement and successful integration of the team and processes.
  • Collaborate closely with to Provider Relations and Provider Contracting teams to ensure seamless, “one-stop shopping” experience and excellent responsiveness to providers.
  • Manage Network Management staff to assure day-to-day activities are performed effectively and support the Region’s network strategy.
  • Meet productivity, turnaround time, and quality standards for credentialing, provider data maintenance, SCAs and other operational processes.
  • Support and participate in the Network Management Department’s process improvement and transformational initiatives to drive completion and successful outcomes.
  • Identify opportunities and implement best practices to standardize network management activities. Assure adoption of best practices by team members.
  • Develop strong provider relationships built on excellent performance and responsiveness. Balance Beacon and provider expectations.
  • Collaborate with the Quality and Legal Departments to perform complaint and grievance resolution and communication.
  • Contribute to provider communications such as newsletters, handbook, mailings, and training.
  • Act as liaison and maintain productive working relationships with all Beacon departments.
  • Manage credentialing and recredentialing activity of MBHP providers including maintaining state-specific credentialing criteria and policies and procedures where required.
  • Manage the administration and tracking of Region 1 SCAs and coordinate with other teams as needed to facilitate completion of requests, including inquiries related to initial requests, exception requests and follow up requests.
  • Take a lead role for Massachusetts-specific NCQA / SOC 1 / EQRO audits pertaining to Massachusetts provider files, credentialing and re-credentialing and provider data maintenance.
  • Collaborate with Corporate Provider Initiatives and Credentialing Teams to harmonize all credentialing policies and procedures.
  • Works closely with the Director of Provider Directories to oversee the provider search functions of the MBHP / HNE / Beacon Health Options websites for accuracy.
  • Co-chair the Local Credentialing Committee and work closely with the Medical Director and MBHP Regional Network Directors in credentialing and re-credentialing of the providers.
  • Hire, manage and develop a high-performing team. Establish standards of performance and productivity measures, monitor departmental and staff performance and organizes new initiatives and projects related to performance standards and accreditation activities.  Determine staff goals and improvement initiatives.
  • Participates as necessary in MBHP Risk Management Committee, MBHP Quality Operations Committee, MBHP Rate Committee, Region 1 UMQMCM Committee.
  • Other duties as assigned.

Position Requirements:

Education: Bachelor’s Degree preferred

Relevant Work Experience:

  • Three years’ credentialing and provider data maintenance experience
  • Provider relations and contracting experience, preferably in managed care
  • Two years’ experience with the Massachusetts provider market
  • Professional demeanor, strong written and oral communication skills, strong computer skills, and the ability to learn Beacon’s internal systems
  • Ability to learn quickly
  • Detail-oriented, analytical, highly organized and possessing problem-solving skills.
  • Ability to manage varying job pressures, and meet deadlines and handle multiple tasks simultaneously with minimal supervision.
  • Ability to work in a production environment and meet production and quality goals.
  • Computer literacy and experience with Microsoft office programs (Outlook, Word and Excel), and internet searches.

To Apply:

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Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment.  EOE/AA/M/F/Veterans/Disabled