Responsibilities Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.
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Job Summary: The Sr. Manager of Provider Network leads and manages provider contracting and network developments consistent with the strategic goals of Prominence Health Plan & is responsible for ensuring the satisfaction of Plan Participating Providers by maintaining excellent relationships and facilitating growth and retention. This position is responsible for the development and maintenance of a comprehensive network of physician, hospital, ancillary and supplemental service providers throughout the assigned area, which meets state, federal and accreditation requirements and standards. Responsibilities include effective provider communications and network management, contract negotiations, in depth rate analysis and initial and ongoing education and support for all network products. The Sr. Manager of Provider Network analyzes specific issues pertaining to providers and oversees the management, problem resolution and education of the provider network on Prominences' products, services policies and procedures. Facilitates the development and implementation of educational strategies to effectively communicate to Prominence Health Plan providers and other key audiences as well as current and ongoing educational initiatives . Benefit Highlights: Loan Forgiveness Program Challenging and rewarding work environment Competitive Compensation & Generous Paid Time Off Excellent Medical, Dental, Vision and Prescription Drug Plans 401(K) with company match and discounted stock plan SoFi Student Loan Refinancing Program Career development opportunities within UHS and its 300+ Subsidiaries! · More information is available on our Benefits Guest Website: benefits.uhsguest.com About Universal Health Services: One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World's Most Admired Companies by Fortune; and listed in Forbes ranking of America's Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.
Qualifications Qualifications and Requirements: Bachelor's degree or equivalent experience required. Five years' working experience in managed care. Experience in working with medical claims billing/payment processes Experienced in negotiating provider rates schedules that can achieve the best possible rates per provider, per line of business and can be automated in various claims billing systems. Experienced in analyzing rates, negotiating contracts and preparing documents i.e., Agreements, amendments, reports, analysis, addendums and letters of agreement. Knowledge of provider reimbursement, Medicare reimbursement, coding and HEDIS Measures and care gap reporting preferred. Ability to develop and implement strategic initiatives. Knowledge of Medicare Advantage and ACA risk scores and ability to educate providers and key levers to further enable the health plan's success Understanding of provider office dynamics and optimal approaches to communicating and educating providers and provider staff Understanding of provider reimbursements and coinciding challenges (FFS, CPT code reimbursement, etc.) Ability to effectively communicate in English, both verbally and in writing. Excellent computer skills. Highly developed professional, interpersonal, written and oral communication skills. Experience in building and maintain provider relationships. Highly accountable, organized, detailed Ability to develop and implement strategic initiatives. EEO Statement All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.
We believe that diversity and inclusion among our teammates is critical to our success.
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If you would like to learn more about the opportunity, please contact Bridget Gomez at:
