Flexicare

HDSI: Provider Network Manager (HMO)

Mandaluyong, Metro Manila
Work Type: Full Time
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Job Objective / Purpose

Provider Network Manager supports the overall goals of Flexicare through the strategic growth of the  network of partner doctors, medical and dental facilities.  The incumbent manages the relationship with referral partners by way of consistent communication to identify needs and promote services.  The Manager oversees provider contracts, credentialing and documentation, review of professional fees and medical cases of members.

Duties and Responsibilities

1.  Network Development

  • Develops the provider network by contracting hospitals / doctors requested or referred by members and accounts management team.

  • Negotiates with non-accredited doctors to accept Flexicare rate and eventually participate in Flexicare network.

  • Evaluates current network reach and plans for expansion according to business needs

  • Ensures that each accredited facility has the basic set of MD specialization to serve the needs of Flexicare members


2.  Network Management

  • Ensures harmonious relationship with accredited partners

  • Manages agreed SLAs with partners

  • Proactively organize provider network engagement events (e.g MD night), partner dialogues, etc.

  • Review and assess standard professional fee rates and benchmark with industry standards

  • Manages hospitalization expenses and reviews coverability according to benefit plan


Background and Qualifications

  • 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 relationship

  • 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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Pursuant to the Data Privacy Act of 2012 (R.A. 10173), its Implementing Rules and Regulations, and other issuances of the National Privacy Commission, the RelianceCare Inc., OR it’s subsidiary or affiliate, such as ActiveOne Health, Inc., and Health Delivery Systems, Inc. (also doing business under the name and style of “Flexicare Benefit Solutions and Healthfirst Clinic”), whichever is applicable to this form, ("It" or "the Company", for brevity) commits to protect and keep the confidentiality, integrity, and availability of all personal data provided. It will only use personal information to process job applications. Any questions regarding the Company's privacy notice shall be coursed through Its Data Protection Officer at the following and applicable email addresses: RCI - [email protected], ActiveOne - [email protected], or HDSI - [email protected]