Sr Mgr, Network Operations - Hybrid

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:
Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week
Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week
Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month
Onsite: daily onsite requirement based on the essential functions of the job
Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building
Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.
This position is hybrid within the state of AZ only. This hybrid work opportunity requires residency, and work to be performed, within the State of Arizona.
PURPOSE OF THE JOB
Directly responsible for ensuring coordination of communications between the Medicaid Segment and the provider network, while maintaining a sufficient provider network through avenues such as provider satisfaction, continuous review of network adequacy, and provider demographic accuracy. Oversees Provider Services staff and ensures there is sufficient staff to enable providers to receive prompt resolution to their problems or inquiries and appropriate education about participation in the Medicaid Segment network.
REQUIRED QUALIFICATIONS
Required Work Experience
Minimum of three (3) years’ experience working in network development
Required Education
Bachelor’s Degree in Health Care Administration, Business Administration, Finance, Economics, Accounting, or Management.
Required Licenses
Valid Arizona Driver’s license required as travel is required.
Required Certifications
N/A
PREFERRED QUALIFICATIONS
Preferred Work Experience
N/A
Preferred Education
Master’s Degree
Preferred Licenses
N/A
Preferred Certifications
N/A
ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
Lead the team and projects on a proactive, timely, accurate, strategic, and independent basis while producing successful results.
Oversee and has direct accountability for relationship management, managing trends and provider issues, staff management, and provider database management for hospital, ancillary, and physician contracting.
Develop goals, work plans, and schedules for Provider Network Management staff and ensure that they are executed.
Routine, proactive, and meaningful interaction with internal departments, including, but not limited to Reimbursement Services, Clinical Operations, Prior Authorization and Member/Provider Services to ensure terms and/or provisions in executed contracts are implemented as intended.
Represent administration at provider meetings (JOC Meetings).
Achieve financial objectives.
Communicate job expectations to staff.
Plan, assign, monitor, and appraise employee’s job results.
Develop, implement, and enforce policies and procedures.
Maintain, train, orient, mentor, and evaluate staff.
Ensure staff have tools needed to be successful.
Set example of proper behavior and accountability to employees and serve as a role model for what is expected of a Medicaid Segment employee.
Annual department budget is prepared timely and adhered to.
Policies and procedures are updated annually (more often if necessary).
Staff is maintained at an adequate level and receives appropriate training to perform job
Staff have clearly defined and up-to-date job descriptions with specific goals and objectives.
Employee issues (performance, behavior, compliance with policies, etc.) are addressed timely and appropriately in accordance with company policies.
Valid Arizona Driver’s license required as travel is required.
The position has an onsite expectation of 2 days per week and requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
REQUIRED COMPETENCIES
Required Job Skills
Experience with network operational systems and processes
Experience leading development of proactive and effective provider relations
Experience building and managing onsite and remote teams
Track record of improving processes, teams, and performance
Strategic and critical thinking skills
Problem solving/analysis
Strong Presentation Skills
Required Professional Competencies
Experience collaborating with teams, vendors, and resources
Independent decision-making abilities
Results driven and client focused
Initiative and proven organizational skills
Proactive problem-solver focused on quality improvement
Computer experience necessary
Effective interpersonal and communication skills
Ability to multi-task and prioritize work tasks to adhere to deadlines and identified time frames
Ability to manage large workload
Ability to maintain positive work relationships experience and knowledge of general health plan operations
Required Leadership Experience and Competencies
N/A
PREFERRED COMPETENCIES
Preferred Job Skills
N/A
Preferred Professional Competencies
N/A
Preferred Leadership Experience and Competencies
N/A
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Our Commitment
AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.

Skills
Accounting