The Manager, ACO Networks provides market oversight for the current Texas ACO and CIO networks through continuous interaction with potential and participating physicians, practice staff as well as ACO/CIO leadership, and that is compliant with the regulatory and other oversight and accreditation agency standards as well as payer network access requirements. This specifically includes ensuring the oversight and implementation of CMS requirements for Tenetâ��s Medicare Shared Savings Program. The position is responsible for developing and executing on a plan to assure adequate network participation by all provider types: physician, facility, ancillary, etc., and for maintaining all demographic information as well as credentialing updates and ensuring acquiring facility privileges related to the provider network. The position is also responsible for ensuring that all necessary practice onboarding is completed and for managing ongoing practice communications related to Gaps in Care, new payer agreements and other ACO quality improvement initiatives such as continuity of care. The individual also has a leadership role in developing and managing communications and other related materials for the ACO board meetings.
Responsibilities are more specifically defined as follows:
Conduct and schedule in-person or virtual meetings with hospital leadership to provide network updates and strategies on improving market KPIs and network integrity
Collaboration with Hospital leadership and Business Development teams at services line, marketing/communication, and other relevant meetings for alignment of physician recruitment and network development strategy
Responsibility for provider recruitment using standardized recruitment tools and protocols to ensure network adequacy
Schedule, prepare material and conduct quarterly network ACO and CIO Board and physician committee meetings
Coordinate provider education related to HCC coding/documentation education and other payer quality metrics
Onboard new providers to the ACO and CIN networks using approved protocol
Management and oversight of network support with low performing providers, provider education plans to ensure compliance with clinical integration program quality metrics
Engagement with contracted vendors and CCN participants for improved post-acute KPIs; development of ongoing post-acute education through 1:1 sessions, physician forums as well as targeted small group provider meetings
Management of onboarding and/or ongoing involvement of local employers, TPAs or other purchasers who utilize our ACO/CIN network for employee benefits/wellness.
Some travel may be required.
Minimum 5 yearsâ�� experience in physician operations, provider relations or network development in a health care or managed care setting required. Preferred experience in post-acute or managed care setting. Degree in business, health care administration or related field preferred. Advanced or clinical degree preferred.
Industry Knowledge and Skills
High-level problem-solving skills
Ability to present to executive leadership
Ability to produce reports and presentations to submit to executive level members
Accountable Care Organization, population health and value-based programs
Health Plan network adequacy and credentialing process
Life cycle of a claim
General knowledge of case management and post-acute discharge planning process
CPT II and ICD 10
HEDIS, PQRS, MACRA/QPP
Proficiency with SalesForce, Microsoft Office, including excellent knowledge of Excel and Power Point
Primary Location: San Antonio, Texas
Facility: 979-Dallas, Texas
Other Locations: Dallas,El Paso
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Internal Number: 2105011102
Tenet Healthcare Corporation (NYSE: THC) is a diversified healthcare services company headquartered in Dallas with 112,000 employees. Through an expansive care network that includes United Surgical Partners International, we operate 65 hospitals and approximately 510 other healthcare facilities, including surgical hospitals, ambulatory surgery centers, urgent care and imaging centers and other care sites and clinics. We also operate Conifer Health Solutions, which provides revenue cycle management and value-based care services to hospitals, health systems, physician practices, employers and other clients. Across the Tenet enterprise, we are united by our mission to deliver quality, compassionate care in the communities we serve.