We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

The IPA Administrator for Prospect owned CA IPAs will engage with MSO leadership, IPA physicians and stakeholders to ensure quality, membership growth and financial success. May manage an assigned "book of business" which may include multiple Prospect affiliations. Responsible for negotiating and securing exclusive contracts, identifying and driving business acquisition or management opportunities, identifying opportunities and driving membership growth with current physicians and recruitment of new physicians. Ensure performance results with revenue driven and company wide initiatives, proactively resolving issues, and effectively communicating directly with physicians, office staff and internal departments. Administer effective marketing efforts to successfully achieve membership growth targets.

Job Responsibilities/Duties

• Work closely with medical directors and Performance Department to monitor utilization of health care services, RAF improvement and overall quality of care. Duties include the following: Conduct Board of Directors or JOC meetings, QA/UM committee meetings and other meetings as appropriate; Oversee the compliance and participation of network physicians to ensure providers are responding timely and accurately to global requests made by internal departments; Ensure physician adherence to regulatory guidelines.
• Identify opportunities to achieve membership growth by developing and capitalizing on relationships with physicians and pursuing business opportunities to support company wide revenue goals including but limited to the following: Identify and pursue standard, semi-exclusive and exclusive contracts with primary care physicians who have membership growth opportunities and lead successful execution and implementation plan; Assist with procurement and recruitment of specialists and maintain active involvement in ensuring specialist network is market competitive to drive membership growth; Develop sales call plan for assigned region and achieve physician and membership goals for assigned territory; Identify and pursue business acquisition opportunities for senior management to explore and act as liaison between Prospect and physician through the review and implementation process; Identify management opportunities with IPAs and groups and directing leads to senior management for review and consideration; Performs / conducts Business Development functions to achieve membership growth to include: PCP recruitment, broker campouts, health plan representative and broker meetings, marketing strategies to promote growth, senior & commercial events, etc; Actively work with network hospital(s) to identify and recruit new PCPs and high volume hospital admitters; Recognize membership growth opportunities within established provider network and strategize methods to capitalize on growth via IPA consolidation, FFS Medi-Medi conversions into Managed Care product, Age in strategies, etc.; Identify gains and losses and develop specific action plans to drive positive results for membership growth; Track and trend growth and losses and report to management.
• Conduct routine visits to all providers as outlined in department policies: 1) to ensure performance compliance with revenue driven initiatives, 2) to engage in open face to face dialogue with physicians to communicate / educate important issues and updates, 3) ensure effective problem resolution, and 3) facilitate communication between the Provider Relations Department and Provider.
• Ensure all assigned providers are compliant with company-wide initiatives including Encounter Data, HCC and P4P programs, membership growth, MLR targets, etc.
• Ensure provider is well educated about the programs and implement specific workflows to meet initiatives and produce positive results.
• Track and report performance to measure results on an on-going basis and develop action plans for those non-compliant providers.
• Ensure high level of participation by providers and office staff at all company events for education and training purposes.
• Oversee support staff to achieve compliance results with initiatives.
• Conduct Office Manager Meetings for assigned network physicians and develop plan to ensure high level of attendance.
• Maintain positive business relationships to ensure retention of existing providers, therefore, decreasing the potential membership loss due to provider terminations.
• Timely report of any potential terminations and strategize to salvage relationship and/or retain membership.
• Coordinate successful implementation of any membership transfers to ensure members remain with the company, to include developing transition plans with Member Relations to achieve the greatest retention of members, coordinating meet and greet functions with receiving physician office, developing member letters for receiving physician to send out, etc.
• Comply with production reporting requirements as stated in Department Policies and procedures by required time frame.
• Analyze global performance of entire network across all departmental and company objectives and identify non complaint providers.

Qualifications

Minimum Education: Four (4) year college degree preferred.

Minimum Experience: Minimum of five (5) years of HMO/IPA experience in Network Management or Contracting. Working knowledge of IDX. IPA Operations experience strongly recommended. Previous supervisory experience preferred.

Req. Certification/Licensure: None.

Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals, benefit eligible positions will receive:

• Company 401K
• Medical, dental, vision insurance
• Paid time-off
• Life insurance

How to Apply

To apply for this role, or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www.eeoc.gov/