Manage day to day operations; provide leadership, support, and direction to the Provider
Performance Oversight and Network Education and Training staff. Ensure the highest level of
provider education, training, and oversight to ensure the network stays informed regarding
policies and procedures, DHCS All Plan Letters and other State and Federal regulations. Monitor
provider performance and identify opportunities for improvement. Monitor established goals and
meet deadlines. Retain provider network through excellent customer service and education.

▪ Manage daily operations of Network Education and Training and Provider Performance
Oversight teams
▪ Provide direction, support, and supervision to staff
▪ Responsible for all provider education and training programs and oversight activities
▪ Develop provider education materials
▪ Create provider bulletins and newsletter articles
▪ Establish and monitor corrective action plans
▪ Enhance use of webinars, video conferencing, new technology for provider education
▪ Conduct public meetings as facilitator or educator, requires excellent public speaking skills
▪ Oversight and participate in provider education/training sessions
▪ Establish goals, monitor activities and ensure timelines/goals are met
▪ Conduct targeted provider education based on reports and monitor effectiveness of trainings
▪ Liaison to Claims department/claims resolution staff for provider issues
▪ Liaison to Health Services department
▪ Assist with resolution of provider complaints/appeals/issues
▪ Establish strong working relationships with key provider billing and authorization staff
▪ Develop agenda topics and oversee Provider Education and Networking meetings
▪ Accompany Representatives from PR, Claims, and Health Services on Hospital/Large
Group Operations/Service meetings.
▪ Review Partnership educational materials and content. Meet with internal Partnership staff
prior to provider meeting to ensure accuracy. Facilitate, lead the meetings.
▪ Provide performance feedback and counseling to staff
▪ Provide staff development and education.
▪ Conduct annual performance reviews.
▪ Act as back up to other Provider Relations department Managers, Associate Director and
Director when needed.

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:

$103,059.95 - $133,977.94

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 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.