Healthcare Network Strategist

1 week ago


Mandaluyong City, National Capital Region, Philippines ACTIVEONE HEALTH, INC. Full time
Job Overview

The Provider Network Manager plays a pivotal role in driving the strategic growth of Flexicare's network of partner doctors, medical and dental facilities. This key position is responsible for managing relationships with referral partners through consistent communication to identify needs and promote services.

Key Responsibilities
  • Network Development:
    1. Develops the provider network by contracting hospitals/doctors requested or referred by members and accounts management team.
    2. Negotiates with non-accredited doctors to accept Flexicare rate and eventually participate in Flexicare network.
    3. Evaluates current network reach and plans for expansion according to business needs.
    4. Ensures that each accredited facility has the basic set of MD specialization to serve the needs of Flexicare members.
  • Network Management:
    1. Ensures harmonious relationship with accredited partners.
    2. Manages agreed SLAs with partners.
    3. Proactively organizes provider network engagement events (e.g., MD night), partner dialogues, etc.
    4. Reviews and assesses standard professional fee rates and benchmarks with industry standards.
    5. Manages hospitalization expenses and reviews coverability according to benefit plan.

Requirements
  • Candidate must be a Doctor of Medicine.
  • At least 2 year(s) of solid working experience in the related field and with a successful track record required for this position.
  • With experience working in TPA/HMO or insurance companies.
  • At least Level 2 Computer Skill Literacy (Basic Computing and Applications).
  • Knowledgeable in PHIC, ICD, CPT, RUV computation.
  • Ability to do on-site visits within Metro Manila and work on weekends and extend beyond company operating hours when needed.
  • Excellent negotiation and account management skills.
  • Good communication (written and oral), interpersonal, problem resolution and critical thinking skills.
  • Ability to develop strong provider relationships.
  • Strong organizational, multi-tasking and time-management skills.
  • Proven ability to work independently and as a team member.
  • Adheres consistently to the RCI values.


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