Provider Network Associate

About the position

The Provider Network Associate serves as a liaison to the Santa Clara Family Health Plan's (SCFHP) network of providers, hospitals, and health systems. This role is integral to the Provider Network Management and MLTSS teams, focusing on delivering exemplary customer service and training to providers while ensuring compliance with state and federal regulations, as well as SCFHP policies and procedures.

Responsibilities

• Represent SCFHP in the provider community at internal and external meetings and events.
• Act as the primary provider liaison, responding to and resolving complex provider questions and complaints in a timely manner.
• Assist providers in navigating SCFHP operations and compliance regulations.
• Communicate effectively with providers at all levels and document issues and feedback accurately.
• Collaborate with team members to resolve operational issues and improve cross-departmental processes.
• Monitor the provider network for adequacy and access issues, taking action to improve service quality and member satisfaction.
• Create and deliver provider orientation and training sessions within established timeframes.
• Develop and execute annual provider communication plans, including site visits and training schedules.
• Maintain knowledge of SCFHP functions to identify operational issues related to claims and provider disputes.
• Build expertise in managed care and relevant regulatory requirements to enhance provider training and communication tools.
• Participate in staff training and assist with new hire training by providing feedback to management.
• Attend and participate in various operational meetings and training sessions, including off-site meetings as needed.
• Initiate and manage process improvement projects in response to operational issues or regulatory changes.
• Perform other related duties as required or assigned.

Requirements

• Bachelor's Degree in Social Sciences, Business, or related field, or equivalent experience.
• Minimum three years of experience in a managed care setting, provider organization, or health policy organization.
• Ability to build and maintain professional relationships with providers and manage complex problems.
• Knowledge of Medi-Cal, Medicaid, and/or Medicare managed care programs is preferred.
• Ability to create and deliver effective presentations and communicate with diverse groups.
• Valid California driver's license and acceptable driving record for offsite meetings.
• Proficient in adapting to changing situations to support department operations.
• Ability to meet accuracy and timeline requirements for regulatory compliance.
• Working knowledge of computer software including Outlook, Word, PowerPoint, and Excel.
• Excellent communication skills for service to internal departments and providers.
• Ability to exercise good judgment and maintain confidentiality.
• Ability to comply with all SCFHP policies and procedures.
• Ability to perform the job safely with respect to others and property.

Nice-to-haves

• Knowledge of Medi-Cal, Medicaid, and/or Medicare managed care programs.