DEPARTMENT(S):  Health Network Provider Relations REPORTS TO:  Supervisor, Health Network Provider Relations FLSA STATUS:  Non-Exempt SALARY GRADE:  C - $41,000 - $53,000

JOB SUMMARY

The position will be responsible for performing functions and tasks related to Health Network Provider Relations, which includes researching policies, preparing reports, assisting with health network inquires, and performing a wide variety of supporting tasks to assist the department’s compliance with regulatory and operational requirements/deadlines. The Program Coordinator (PC) will be responsible for ensuring timely follow-ups on health network deliverables, reviewing, and maintaining the department inbox and the Health Network Provider Relations folder, assisting with health network forums and meetings, and other assigned duties.

POSITION RESPONSIBILITIES:

• Assists with updating, maintaining, and ensuring that all health network requests via the department inbox are monitored and responded to timely.
• Tracks and monitors health network reporting, deadlines, and deliverables.
• Prepares and provides ad-hoc reports.
• Assists with the documentation and updating of internal workflows and desktop procedures.
• Researches issues to assist with the resolution of health network inquires and escalated member cases.
• Prepares meeting materials and assists with meeting set-ups and minute-taking as needed.
• Works on special projects and other duties, as assigned.

POSSESSES THE ABILITY TO:

• Problem-solve and/or to triage questions to appropriate internal and external entities.
• Build working relationships with staff of all levels.
• Prioritize and organize work to meet challenging deadlines, and have strong organizational skills.
• Adapt to constantly changing priorities in managing various projects simultaneously.
• Maintain a high degree of credibility, confidentiality, integrity, and professionalism in a high-pace environment.
• Work independently and be highly self-motivated with minimal supervision.
• Demonstrate creativity, initiative, and good judgment while providing a high level of customer service to internal and external entities.
• Take direction and work as part of a team in the department.
• Communicate clearly and concisely, both verbally and in writing.
• Utilize and access computer and appropriate software (e.g., Microsoft: Word, Excel, PowerPoint, Access, Visio, and SharePoint) and job-specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position.

EXPERIENCE & EDUCATION:

• High school diploma or equivalent required.
• 1 year of Health Care Administration experience required.

PREFERRED QUALIFICATIONS:

• Associate degree in Business Administration, Health Care Administration, or related field preferred, and/or an equivalent combination of education and experience sufficient to successfully perform the essential duties of the job such as those listed above.
• Medicare / Medi-Cal experience preferred.

KNOWLEDGE OF:

• Managed care provider and health care industry practices.

CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.

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Required Skills Required Experience