Contracted Network Specialist - PACE
hace 19 días
Murrieta
Job Description Community health is about more than just vaccines and checkups. It’s about giving people the resources they need to live their best lives. At Neighborhood, this is our vision. A community where everyone is healthy and happy. We’re with you every step of the way, with the care you need for each of life’s chapters. At Neighborhood, we are Better Together. Neighborhood Healthcare PACE is a managed medical plan built around surrounding participants with a team of physicians, nurses, social workers, therapists and care coordinators to help them maintain good health and a good quality of life. Our goal is to keep our seniors happy and healthy at home surrounded by their family and community. As a private, non-profit 501(C) (3) community health organization, we serve over 500k medical, dental, and behavioral health visits from more than 100,000 people annually. With two PACE centers located in Riverside County, our PACE program is positioned to serve over 650 senior participants. The Contracted Network Specialist – PACE supports the execution of PACE provider network strategy by managing day-to-day contracting, provider onboarding, credentialing coordination, and ongoing provider relationship management. Reporting directly to the PACE Contracted Network Manager, this role is responsible for ensuring timely, compliant, and provider-centered execution across the full provider lifecycle. This position serves as a key operational partner to internal teams and external providers, helping translate network strategy into action by coordinating onboarding, maintaining credentialing and contract compliance, supporting renewals, and fostering strong, collaborative provider relationships that enable timely access to high-quality care for PACE participants. This is a full-time, hybrid position. This position will be based in Escondido, with ongoing travel required to our PACE centers, provider offices, and affiliated facilities to support network development and relationship management. Responsibilities • Coordinate end-to-end onboarding for new PACE providers and vendors, ensuring all required documentation is requested, received, reviewed, and submitted accurately and timely., • Oversee and maintain provider credentialing to ensure full compliance with DHCS and PACE regulatory requirements., • Support primary source verification activities, including licensure, education, training, work history, sanctions, and professional qualifications., • Track onboarding and credentialing progress, proactively following up with providers and internal stakeholders to resolve gaps or delays., • Maintain organized, complete, and audit-ready onboarding and credentialing records across designated systems., • Support ongoing credentialing monitoring, including updates, recredentialing cycles, and escalation of potential compliance concerns to the Manager., • Draft, review, and support negotiation of PACE Provider Agreements, Single Case Agreements, amendments, MOUs, and related documents under the direction of the Manager., • Coordinate execution of contracts, amendments, renewals, and terminations, ensuring accuracy and timeliness., • Track contract key dates, renewal cycles, and termination notice requirements; provide proactive alerts to stakeholders., • Manage collection, tracking, and compliance with Certificates of Insurance and related contractual documents., • Enter and maintain accurate contract data in Coupa, SharePoint, Asana, and other designated systems., • Escalate non-standard terms, compliance questions, or risk concerns to the PACE Contracted Network Manager., • Serve as a primary day-to-day point of contact for contracted PACE providers on onboarding, credentialing, and contract-related questions., • Support ongoing provider engagement, including coordination of annual PACE competency reviews and required training., • Assist with hospital, skilled nursing facility, assisted living facility, home care, home health, specialty providers and ancillary provider outreach aligned with network development priorities., • Collaborate with Operations, IDT partners, and Medical Leadership to help resolve provider access issues, referral challenges, and onboarding barriers., • Maintain provider network matrices and tracking tools to ensure coverage across required PACE services and geographies., • Foster professional, responsive, and collaborative relationships that support high-quality, participant-centered care., • Support annual compliance verification efforts using established oversight and compliance checklists., • Assist with preparation for audits, reviews, and regulatory inquiries related to provider contracting, onboarding, and credentialing., • Generate and maintain reports related to onboarding status, credentialing progress, contract renewals, and provider documentation., • Contribute to the development and maintenance of standard operating procedures and workflow documentation for PACE contracting and network operations., • Identify process improvement opportunities and provide recommendations to the Manager to enhance efficiency, accuracy, and turnaround times. Quality Management • Contributes to the success of the organization by participating in quality improvement activities. Customer relations • Responds promptly and with caring actions to patients and employees, • Maintains professional working relationships with all levels of staff, clients, and suppliers, • Works with outside vendors to maximize quality of vendor and Neighborhood relationships to ensure industry respect, • Impacts patient experience by demonstrating courteous and helpful behavior and a commitment to accuracy Qualifications Education/Experience • Bachelor’s degree or equivalent combination of education and experience required, • Minimum of 5 years of experience in provider contracting, credentialing, provider onboarding, or managed healthcare operations required, • Experience supporting PACE programs, provider networks, or regulated healthcare delivery systems preferred, • Familiarity with CMS, DHCS, and healthcare credentialing standards preferred, • Current Basic Life Support (BLS) certification required upon hire and must be maintained as a condition of employment. These courses must follow AHA guidelines- may be completed through approved online providers such as ProMed or other equivalent programs that meet recognized BLS standards., • In addition, current CPR and First Aid certification are required for all PACE employees in accordance with CMS and DHCS requirements. First Aid training will be provided at onboarding and must be renewed annually Additional Qualifications (Knowledge, Skills and Abilities) • Strong working knowledge of provider onboarding, credentialing, and contracting workflows, • Excellent organizational skills with the ability to manage multiple concurrent priorities and deadlines, • Strong written and verbal communication skills, including provider-facing communications, • Ability to build effective working relationships with providers and cross-functional teams, • Attention to detail and commitment to compliance and data accuracy, • Proficiency with contract lifecycle, onboarding, and project management systems (e.g., Coupa, SharePoint, Asana), • Ability to handle sensitive and confidential information with professionalism and discretion Physical Requirements • Ability to lift/carry 10 lbs, • Ability to sit/stand for long periods of time Neighborhood Healthcare offers a generous benefit plan that includes: Partially company paid Medical, Dental, and Vision Plans. Two plus weeks of vacation, Nine Holidays including two Floating Holidays of your choosing, Sick/Personal time, Volunteer Time Off (VTO), 403b Retirement plan (similar to a 401k), optional Health and Wellness events, and much more! Pay range: $38.55 - $55.52 per hour, depending on experience. Compensation Disclosure: The posted salary range reflects the designated pay grade for this position. While this range represents the broader classification of the role, actual compensation will be based on several factors, including but not limited to the candidate’s overall knowledge, skills, and experience, market data and industry benchmarks, internal equity within the organization, Budgetary considerations and organizational needs. As a result, placement within the range is not guaranteed, and the full pay grade range may not be utilized.
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