Network Management Representative

This position is responsible for maintaining a working relationship with provider organizations as assigned. Acts as the liaison to providers and health plans, assesses provider-training needs, ensures compliance with contracts. Arranging for and conducting office manager meetings and physician meetings. Works collectively and individually to complete new provider orientation for all applicable product lines. Conducts face-to-face visits to service providers, resolve issues, educate staff/providers on policies, assist in collecting credentialing information, and review HEDIS information.

Assess the changing needs of assigned network, identifies network gaps and collaborates with Contracting Department. Provides oversight on escalated inquiries and claim issues and follows up with providers to ensure problems have been resolved, strategizes for membership growth and retention, work closely with brokers, other vendors and health plans, as well as works special projects as assigned or directed.

PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 37 outpatient medical office buildings, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women’s health, urgent care and emergency services.

The organization is nationally recognized for excellence in patient care and patient experience, and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.