Provider Network Specialist jobs in San Jose, CA

Description

Under general direction, to plan, organize, direct and control the activities and/or staff of a County program.

• Experience in working with various provider types and specialties in a health plan network.
• Experience in ensuring compliance with regulatory and accreditation standards (i.e. DCHS, and DHMC, NCQA).
• Experience in negotiating contracts with provider networks that align with a health plan organization’s operational goal.

Typical Tasks

• Plans, organizes and directs a County program that provides direct service to the public or other agencies;
  
• Determines program objectives in light of established goals;
  
• Develops strategies to achieve objectives;
  
• Establishes program priorities;
  
• Formulates and implements policies, plans and procedures for carrying out functions of the program;
  
• Defines personnel resource needs and allocates them as required to reach program objectives;
  
• Selects and hires staff and ensures the orientation, training and development of program staff;
  
• Directs and evaluates the work of subordinate staff;
  
• Establishes an appropriate organizational structure and delineates working level and relationships of personnel to carry out the program's activities;
  
• Determines budgetary requirements to maintain the program;
  
• Makes recommendations on the annual budget and may present the program's budget to the Board of Supervisors;
  
• Is responsible for determining program funding needs and obtaining available outside funding when necessary through grants and/or contracts;
  
• Is responsible for the implementation, control, monitoring and evaluation of provided services to ensure compliance with terms of received grants and contracts;
  
• Maintains liaison relationships and represents the program in contacts with public and private agencies and concerned community groups and organizations;
  
• Prepares reports and correspondence;
  
• Keeps abreast of new trends and developments related to the program's activities;
  
• Provides assistance and advice to advisory and planning boards, commissions, task forces and other special groups as required;
  
• May prepare and make presentations to staff, boards, commissions, and external groups;
  
• May provide ongoing statistical reports;
  
• May be assigned as a Disaster Service Worker, as required;
  
• And performs related duties as required.

Employment Standards

Sufficient education, training and experience to demonstrate the possession and direct application of the following knowledge and abilities.

Training and Experience Note: The required knowledge and abilities are typically attained through training and experience equivalent to possession of a Bachelor's degree. Relevant experience can substitute for education on a year-for-year basis. Relevant experience includes experience performing analytical, administrative, lead, supervisory, or management duties, which include interpreting rules and regulations, gathering data and formulating recommendations, and report writing.

• it is an absolute necessity for the successful operation of the program;
• that the Program Manager will be held accountable for this specialized knowledge; and
• that subordinate program staff will not be able to provide the subject matter expertise that is required.

• Program development and evaluation;
  
• Techniques of organizing and motivating groups;
  
• Personnel management techniques;
  
• Methods of administrative problem solving;
  
• Principles of organization and administrative, fiscal and program management;
  
• Principles of employee supervision, training and development;
  
• Community and agency consultation methods and procedures;
  
• Computer applications, including but not limited to: word processing, spreadsheets, data base management software, presentation and electronic mail software.
  

• Plan, organize, control and evaluate a public service program;
  
• Manage initiatives, collect and analyze data for the purpose of evaluating services and or programs;
  
• Plan and assign workloads clearly and effectively;
  
• Train, develop and motivate staff;
  
• Deal effectively with a variety of government and community officials;
  
• Speak effectively in public;
  
• Integrate the activities of a program to attain program goals;
  
• Prepare and review reports;
  
• Develop and recommend effective courses of action;
  
• Develop and effectively utilize all available resources;
  
• Establish and maintain program's objectives, priorities and policies;
  
• Consult with and advise top administrator on the activities and status of the program;
  
• Develop short and long range budget plans that accurately reflect program needs.
  
• May require the ability to apply the tools of a specialty subject area.