ROLE AND RESPONSIBILITY
The Workers’ Compensation Networks Manager is responsible for the ongoing daily operations and compliance activities of MEDEX’s Workers’ Compensation Health Care Organization (HCO) and Medical Provider Network (MPN) network administration. MEDEX is the premier source of exclusive and specialized healthcare networks for major California employers, and has filed many of the state’s first HCOs and MPNs.
In collaboration with other subject matter experts, and using his or her applied knowledge of the California Workers’ Compensation laws, regulations, and industry, the Networks Manager is a primary leader in developing, maintaining, change managing, and otherwise overseeing the functioning and advancement of multiple MPNs and HCOs. The Networks Manager supervises, trains, coaches, and monitors department staff, executes projects, manages departmental daily activities such as applying network changes, achieving and maintaining network certifications and compliance, executing employee notification campaigns, creating and maintaining documentation and reports, acting as a knowledgeable liaison with clients, vendors, intercompany departments, and other partners, and collaborating with the leadership team to meet business objectives and maintain compliance.
The ideal candidate will have demonstrated success in Workers’ Compensation healthcare networks and/or managed care, particularly in administration of MPNs. This individual should have excellent professional communication skills and team-oriented leadership experience that will allow them to act as an effective manager of longtime team members while continually making process improvements and appropriate documentation. This well-rounded Workers’ Compensation professional should also have familiarity with the California Workers’ Compensation provider community, proficiency in related technology, and excellent project management skills.
PRIMARY DUTIES
- Oversee the optimal functioning of HCO and MPN network administration using their applied knowledge and experience in California Workers’ Compensation laws and regulations
- Implement and/or maintain procedures and standards to ensure that department duties are conducted in accordance with applicable laws, regulations, company policies, and department and client standards
- Develop and/or modify SOPs for all department functions and subfunctions
- Manage the creation, review, maintenance, and updating of network data
- Manage the activities, recordkeeping, standards, performance, and infrastructure of the MPN Medical Access Assistant functions
- Run, audit, analyze, and maintain monthly HCO and MPN reports, both internal and external
- Identify, implement, monitor, analyze, and modify required process changes or improvements with a focus on efficiency, user benefit, compliance, transparency, accuracy, and speed
- Assist Healthcare Networks Director and Chief Legal Counsel with state filings for MPN and HCO programs as necessary
- Plan, execute, and manage projects related to the department and any sub-functions
- Collaborate with IT resources, leadership, and other personnel to implement enhancements and other changes to department systems, applications, and technology
- Develop and/or maintain procedures for proactively detecting network deficiencies and remediation activities
- Create, maintain, analyze department activity grids; act upon findings
- Generate, analyze, audit, maintain, and deliver monthly client reports; knowledgeably respond to questions and concerns
- Act as a knowledgeable, courteous, and timely escalation point for inquiries from clients, other departments, staff, vendors, and others
- Manage the development, review, scheduling, and mass mailing of HCO and MPN notifications on behalf of clients
- Manage the progress and recordkeeping of client requests, employee notifications, and other network actions that implicate clients’ legal and financial interests
- In collaboration with IT resources, administrate the Company’s SFTP site to effectuate secure transmission of files between our systems and stakeholder systems; provide clients with administrative support for use of the SFTP (such as modifying user permissions, adding or disabling client users, etc.)
- Lead new client network implementations, including EDI/API/automated setup, developing and filing related network certifications, creating and delivering any required client training, creating and delivering any required client/claims administrator instructions, communicating about and participating in new client implementation meetings, and any other activities required for implementations
- Lead, moderate, and/or participate in meetings, including department meetings, project management meetings, vendor meetings, leadership meetings, client meetings, and other meetings relevant to the activity and ongoing optimization of the department
- Participate in receiving, responding to, and managing grievances or complaints brought against the Company’s networks by injured workers, clients, claims administrators, providers, or any other entity entitled to file a grievance or complaint
- Develop accurate, effective, updated training material as necessary; deliver appropriate training to staff; maintain related records
- Responsibly manage staff, including hiring, coaching, disciplining, closely monitoring work performance, facilitating compliance with applicable labor, employment, confidentiality, safety laws and policies, scheduling, conducting regular performance reviews, mentoring, training, and overall personnel development and maintenance for optimal department functioning
- Collaborate with leadership to advance department goals
- Knowledgeably contribute to questionnaires, proposals, interviews, forms, documents, reports, etc. as necessary for insurance, client, accreditation, audit, public reporting, legal, or other business needs
- Support the identification, communication, monitoring, and resolution of department issues
- Support the Director of Healthcare Networks in their duties, act as primary backup for related leadership and staff duties
- Serve as an expert witness before the WCAB regarding department processes with the support of other internal experts, as necessary
- Other duties as required to maintain and advance the operation, compliance, business development, efficiency, and effectiveness of the Company’s Workers’ Compensation networks
- Conduct all activities with the highest degree of ethical conduct, including the securing and nondisclosure of confidential, private, and otherwise sensitive information including PHI, PII, IIHI, trade secrets, financial information, and other confidential information
REQUIRED QUALIFICATIONS
- 3+ years of professional experience in Workers’ Compensation network operations, with an emphasis on MPN programs
- 3+ years of experience as a team lead, supervisor, manager, or other leadership role in the Workers’ Compensation industry or a related field
- 2+ years of project management experience including managed care components with an emphasis on EDI/API implementations
- Proficiency in Microsoft Office programs, including Word, Outlook, Teams, SharePoint, PowerPoint etc.
- Proficiency in Microsoft Excel, including the following skillset: running pivot tables, running accurate graphs/charts, creating tables, running data analysis
- Proficiency in data entry (10-key, typing 50+ WPM)
- Excellent attention to detail and recordkeeping skills
- Professional, clear, and productive communication abilities, both verbal and written
- Ability to effectively, collaboratively, and efficiently manage staff
- Demonstrated success in leadership, teamwork, and professionally representing the Company before clients, partners, vendors, prospects, attorneys, and other outside parties
- Excellent time management and delegation skills, with an emphasis on client service and addressing urgent situations
- Prior experience testifying as an expert witness before the WCAB or related legal venue
- Applied experience in protecting and securing PHI, PII, IIHI, and other sensitive or confidential information
- Reliable private transportation
- Resources and ability to work remotely from a secure, private, ergonomic, safe location with high-speed, secure internet service
- Ability to work as needed from our office in Irvine, CA
- Ability to lift, carry, and transport equipment up to 25 pounds unassisted
- Ability to prioritize and complete job responsibilities on time
- Superior applied organizational, project management, and digital recordkeeping skills
- Responsible, self-motivated, collaborative working style
PREFERRED ADDITIONAL QUALIFICATIONS
- Bachelor’s degree, Master’s degree, or other degree or certification in healthcare administration, healthcare informatics, human resources, data analytics, or other relevant field
- 2+ years of professional experience in an administrative healthcare setting
- Prior experience in successfully completing an MPN filing from start to finish
- Demonstrated experience in public speaking, presenting, and/or training
- Prior experience in Workers’ Compensation provider relations, MPN Medical Access Assistant functions, claims administration, managed care, geographic data production, or related field
ABOUT MEDEX
MEDEX is headquartered in Newport Beach and has been a leader in providing Workers’ Compensation services to employers, insurance companies and carriers, and other clients since its founding in 1994. MEDEX is also one of the few organizations qualified by the state of California as a Workers’ Compensation certified Health Care Organization (HCO). We are known for our quality service in minimizing the overall costs of Workers’ Compensation claims by making proper medical care for industrial injuries easily accessible, helping clients navigate the abundant Workers’ Compensation regulations, facilitating efficient and thorough case management, and providing a suite of services that complement our clients’ goals. You can learn more about MEDEX at our website: www.medexhco.com.
MEDEX is an equal opportunity employer.
Job Type: Full-time
Pay: $70,000.00 - $78,000.00 per year
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
- Monday to Friday
Experience:
- MPN: 3 years (Required)
- Supervisory: 3 years (Required)
Ability to Commute:
Work Location: Hybrid remote in Irvine, CA
