Network Engagement Specialist

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We are recruiting for a Network Engagement Specialist in Fresno, CA
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The Network Engagement Specialist is responsible for coordinating necessary ancillary services for members discharged from inpatient and outpatient settings, acute care and post-acute care settings. This role includes overseeing provider communications, issue resolutions, case submissions, and case closures, as well as managing data exchanges with our Care Partners, local hospitals, and other in-network providers. By building strong connections between UPN and our provider partners, the Network Engagement Specialist will enhance collaboration and service delivery.

Additionally, the Specialist will educate local hospitals, skilled nursing facilities, and other ancillary providers on UPN's processes and workflows. This position is crucial for ensuring that members receive the necessary Durable Medical Equipment (DME) supplies and other ancillary services promptly. The Specialist will also facilitate efficient routing to in-network Skilled Nursing Facilities (SNFs) when needed. This role involves a mix of administrative tasks and project management, with a strong focus on enhancing member satisfaction and maintaining effective provider relationships.

The Specialist will work closely with the Chief Medical Officer (CMO) and the Contracting & Managed Care Officer, reporting directly to the Provider Relations Manager.

• Work closely with local hospitals, healthcare providers, and in-network SNFs to coordinate discharge plans and ensure effective member routing.
• Act as the primary point of contact for members requiring DME supplies upon hospital discharge, ensuring timely and accurate delivery of equipment.
• Maintain accurate records of member interactions, equipment requests, and discharge plans in the organization's database.
• Intake Peer-to-Peer requests and process according to established protocols.
• Ongoing, professional, and effective communication with all providers in UPN's network.
• Maintain a professional relationship with all internal and external care partners.
• Provide exceptional customer service.

• Handle administrative tasks related to provider relations, including documentation, reporting, and follow-up communications.
• Assist in the development and implementation of projects aimed at improving processes related to DME supply distribution and member transitions to SNFs.
• Address and resolve any issues or concerns raised by members or providers regarding DME supplies or facility placements.
• Proactively research and resolve provider issues including claims submission, processing, and payment, contracting details, provider tools, and UM and other protocols.
• Ensure accurate ongoing submission of key provider data elements, updates and changes.
• Support providers through the credentialing/re-credentialing process, including addressing provider questions, ensuring timely completion of applications, and supporting UPN's credentialing team.
• Provide orientations to contracted ancillary providers, ensure alignment and understanding of UPN.
• Collaborate with internal and external care partners in the creation and distribution of orientation and educational materials to all levels of personnel within a hospital, and ancillary services settings.
• Build provider awareness and engagement with UPN for potential contract opportunities for ancillary services and hospital partnerships.
• Other network management tasks as assigned not limited to ancillary network.

• Answer UPN customer service phone line to appropriately address and/or reroute inquiries.
• Oversee incoming mail, organize and distribute to the appropriate personnel.
• Audit Health Plan provider rosters and directories to ensure UPN Network providers are listed accurately. Work with the Management Service Organization and Health Plans to address any deficiencies.
• Administrative support to Contracting and Managed Care Officer and Chief…