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The Network Recruiter is responsible for a full range of provider relations and service interactions. They will works with the Director of Behavioral Health Network and Manager of Provider Services on identifying network gaps, needs, and recruitment strategies; identify and execute processes needed to recruit applicant; work with Provider Network Department staff to align recruitment efforts and maintain and ensure the integrity of provider databases; and respond to provider inquiries with exceptional customer service to providers, County partners, peers, staff in other departments and the general public.
As part of this position, you will be required to be granted and maintain access to the County of San Diego's electronic health record, Cerner Community Behavioral Health (CCBH ). In addition please note that if you are currently employed by the County of San Diego, further review of your application will need to occur to ensure that there is not a conflict of interest. Primary Responsibilities:
Accountable for a full range of provider relations including engagement with and development of prospective providers
Design and implement strategies to increase the membership of providers in the network
Create and execute a marketing plan to build and nurture provider network
Identify needs in provider network, incorporating potential gaps related to composition, services, or geographical needs
Support leadership in establishing and maintaining strong business relationships with Hospitals, Physicians, Pharmacies and Ancillary providers, and ensure the network composition includes an appropriate distribution of provider specialties
Identify, coordinate and participate in outreach events to educate community providers on the benefit of network membership
Establish recruiting requirements by studying organization plans and objectives and meeting with managers to discuss needs
Build applicant sources by researching and contacting community services, colleges, employment agencies, recruiters, media, and internet sites and provide organization information, opportunities, and benefits while making presentations and maintaining rapport
Attract applicants by placing job advertisements, contacting recruiters, using newsgroups or job sites
Improve organization attractiveness by recommending new policies and practices, monitoring job offers and compensation practices, and emphasizing benefits and perks
Update job knowledge by participating in educational opportunities, reading professional publications, maintaining personal networks, and participating in professional organizations
Must possess the following skills-Phone and Interviewing Skills , Recruiting, , People Skills, Strong decision-making, Professionalism, Good Judgment, Organizational Skills, Project Management
Support Diversity, Knowledge on Employment Law, Focus on Results
Assume additional responsibilities as assigned
Additional Responsibilities may include:
Complete administrative processes related to the application, credentialing, contacting and re-credentialing of providers
Review all provider applications and documents to ensure compliance with the credentialing criteria for inclusion in the different networks
Track credentialing process and send provider the completed contract once process is complete
Run reports from provider databases to track credentialing and re-credentialing activities for a variety of provider types
Return the signed fully executed contract to new providers in the Fee For Service and TERM networks
Track providers malpractice insurance, DEA, and licensure renewals to ensure they are current/active
Facilitate the resolution of credentialing issues
Coordinate and complete external and internal termination notification requirements
Periodically review state and federal bulletins for provider sanctions and review provider disbarment reports notifying Manager of outcome
Attend and participate in meetings to achieve departmental and interdepartmental goals and objectives
Triage provider related issues and escalate complex problems when necessary to Manager
Respond to claim issues by assessing fee schedule and contract configuration, procedure and diagnosis code questions, review modifiers and other claim form components in order to determine payment accuracy
Organize provider files so they may be easily reviewed by staff, credentialing committee and external review bodies
Accurately enter and maintain Provider data in multiple databases to be used for directories, payments, mailing labels and reports
Document communication with providers in designated databases; assist in managing the integrity of databases by using contacts with providers to verify and update provider files
UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.
We are committed to introducing innovative approaches, products and services that can improve personal health and promote healthier populations in local communities. Our core capabilities... in clinical care resources, information and technology uniquely enable us to meet the evolving needs of a changing health care environment as millions more Americans enter a structured system of health benefits and we help build a stronger, higher quality health system that is sustainable for the long term.
We serve our clients and consumers through two distinct platforms:
?UnitedHealthcare, which provides health care coverage and benefits services.
?Optum, which provides information and technology-enabled health services.