Program Manager Network - HP Network

Summary:

The Program Manager Network is responsible for overseeing the operational, contractual, and strategic functions that support the CHRISTUS Health Plan's provider networks. This role ensures the integrity and efficiency of network data management, contract execution, provider engagement, and event coordination. The Program Manager plays a key role in maintaining compliance with CMS regulations, enhancing provider relationships, and supporting internal teams through content development and communication strategies. This position requires strong organizational skills, cross-functional collaboration, and a proactive approach to improving network operations and provider satisfaction.

Responsibilities:

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Contracts - Oversees all operations of contracts signed for a broad variety of network efforts.
  • Oversees all operations of contracts signed for a broad variety of network efforts.
  • Manages all signing of participant agreements for the ACO and CIN.
  • Oversees necessary iterations to the Medicare Shared Savings Program (MSSP) and complies to all CMS requirements on behalf of the CHRISTUS Health Quality Care Alliance (CHQCA).
  • Ensures compliance with CMS in all activities, including enrollment, contracts, and our public reporting page.
  • Manages all participant adds, changes, and deletes to our ACO in ACOMS.
  • Ensures all historical documentation for contract changes is saved properly in Contract Guardian.
  • Uploads all documents required by CMS to ACOMS, including contracts, financial information, board structure, and other various items.
  • Ensures ACO(s) contract with CMS is/are signed and executed successfully.
  • Manages all signing activities during the various enrollment periods set by CMS.
  • Develops in Contract Guardian a system to track contract status and renewals.
  • Works with the legal team to ensure all contracts meet regulatory and compliance standards.
  • Develops streamlined methods for communication of provider data between contracting, credentialing, and provider data, including:
    • Creates a new process for tracking new provider agreements
    • Submits contracts for five contractors to credentialing, including creation of Uniflow and overseeing tracking until the contract is effective
• Network Data Management - Champions the business needs of Networks to ensure accurate provider and facility data is maintained for various activities.
  • Responsible for creating a master list of in network providers and facilities for various business purposes.
  • Creates and enforces a healthy standardization of provider and facility data to ensure business needs are met.
  • Develops a concrete understanding of the entire workflow of provider and facility data from a big picture perspective to help improve the way we store, collect, and audit our provider and facility data.
  • Identifies potential areas of need for internal audit processes that impact the business in a significant way.
  • Works with various parties such as IT to champion change to benefit our business outputs of provider and facility data.
  • Develops and maintains efficient methods for distributing information about network changes, such as new group orientations, terminations, and various other activities.
  • Manages methods of data collection through tools (like Smartsheet) in regard to various business activities.
  • Develops new reporting methods in HSP using the HSP reporting tool to help various teams with data projects.
  • Smartsheet development and management for Provider Relations activities, including:
    • Creation of tracking dashboard, upkeep of sheet capabilities, update capabilities as requested
  • Smartsheet development and management for Contracting activities, including:
    • Creation of tracking dashboard, upkeep of sheet capabilities, tracking contract "wins", update contract information in relation to credentialing providers, update capabilities as requested
  • Manages continued improvement of Provider Add form automation to ease burden for providers to add attritional clinicians to their current contract.
• Content - Generate all content regarding Health Plan activities.
  • Creates PowerPoints for Health Plan educational events, such as virtual/in person meetings.
  • Coordinates with marketing to develop external content regarding Health Plan activities, specifically regarding providers.
  • Develops slides required by the Provider Relations team for various content.
  • Coordinates with internal teams to develop Health Plan content.
  • Develops handouts used for education purposes regarding Health Plan activities.
  • Works with Provider Relations Managers to ensure an effective workflow is maintained for developing content needed for various business purposes.
  • Manages all distribution of various marketing materials that are sent to the Health Plan network.
  • Coordinates all major distribution of goods/gifts to Health Plan/ACO/CIN network.
  • Coordinates with PS Promotions for HP marketing needs - Networks, Risk Adjustment, ACO, etc.
  • Orders for marketing supplies for Provider Relations Managers to give out to current and potential providers and office staff
  • Orders for in office Network staff needs
  • Develops and researches new marketing supplies for Provider Relations Managers to give out to current and potential providers and office staff
  • Develops workflow Visios that summarize workflow processes for various teams in Networks, including:
    • Claims, Appeals, Member Services, Network Contracting, Network Provider Relations, Care/Utilization Management, Credentialing
    • Working with directors of Health Plan teams to development workflows for each team to improve website processes and lower the volume of unnecessary/misdirected emails from providers and members
    • Will work with IS and BI to develop website linking into online resource that connects to new forms directing to Uniflows/emails to team email boxes, as desired by leadership
    • Development of Network Continuity book creation - Visios and other materials, as needed
• Event Coordinator - Schedules and coordinates events for a broad variety of Health Plan efforts.
  • Defines the objectives and goals for each event.
  • Identifies key stakeholders and their expectations.
  • Develops and manages the event budget; track expenses and ensure cost-effective solutions.
  • Researches and book appropriate venues.
  • Coordinates logistics such as transportation, accommodation, and catering.
  • Creates a detailed event timeline.
  • Schedules meetings and coordinate with participants to ensure availability.
  • Develops a communication plan to keep stakeholders informed.
  • Creates material for events, working with marketing.
  • Identifies and liaise with vendors for services like audio-visual equipment, decorations, and catering.
  • Identifies potential risks and develop contingency plans.
  • Ensures compliance with safety regulations and protocols.
  • Oversees the setup and execution of the event.
  • Gathers feedback from participants and share feedback internally.
  • Oversees the annual Network Development Onsite Meeting
  • Coordinates catering, including consideration of food allergies and preferences and timing of meals with Guckenheimer
  • Handles room reservations and table/chair/AV requirements with Building Facility Manager
  • Plans and makes reservations of team building event and dinner
• Provider Engagement Specialist (Health Plan) - Responsible for coordination of major communication with providers in our health plan network.
  • Manages CHP Network Development email through:
    • Addressing provider inquiries and concerns
    • Facilitating communication with providers and redirecting to other CHP teams, as needed
  • Health Plan Network Participation Request from Providers and Facilities
    • Creation of monthly list for contractors and leading monthly meeting with in-person and remote associates
    • Communication with providers declined from network
    • Communication with providers mistakenly trying to add providers through incorrect form
    • Tracking for triannual Adequacy reporting
  • Manages activities regarding Facility/Ancillary/Professional Termination Letters
    • Multiple cover letters for providers for over 2000 terminations
    • Collaboration with Contractors to find termination language and network adequacy
    • Collaboration with Network team to print, stuff, and send certified return receipt termination letters.
    • Responsible for all marketing content sent to providers for Health Plan activities.
• Miscellaneous - Various responsibilities that support health plan and ACO/CIN activities.
  • Network Development Part-time Interns
    • Day-to-day supervision of intern duties
    • Teach systems - Contract Guardian, HSP, SharePoint, etc - as needed
  • Policies & Procedures Committee Member
    • Edit 3-5 policies for Health Plan teams for each committee cycle
    • Attend committee meetings monthly
  • USFHP Incentive Payment Program
    • Management and distribution of checks for USFHP incentive payment program for PY 2024 and onward

Job Requirements:

Education/Skills

• Bachelor's degree in relevant field such as health administration, business administration, or a related discipline required

Experience

• 2+ years of program management, leadership, or related experience required
• A minimum of 1 year of healthcare experience preferred

Licenses, Registrations, or Certifications

• None

In accordance with the CHRISTUS Health License, Certification and Registration Verification Policy, all Associates are required to obtain the required certifications for their respective positions within the designated time frame.

Work Schedule:

5 Days - 8 Hours

Work Type:

Full Time