Presbyterian Healthcare Services

The role will be responsible for overseeing and managing relationships with our vendors and managed service providers, ensuring that we obtain the highest quality services and value to our customers. This role is crucial in maintaining our high standards of service delivery and customer satisfaction.

Provides oversight of network strategies and relationship development activities for assigned providers including individualized planning, training and development of providers to align with Presbyterian’s clinical quality initiatives. Will provide the framework for physician/provider performance reporting that will assist providers with objective and quantitative analysis of clinical quality performance measures. The Network Relations Service Executive is a professional accountable for proactively identifying issues, resolving disputes, and coordinating resolutions. Accountable for resolving complex problems, fielding general questions, and acting as a liaison between the provider of service and the health plan.

This position is responsible for the overall management of regulatory processes that impact the claims department, with heavy emphasis on the Medicare Advantage and Medicaid lines of business. It involves implementing regulatory and plan design processes to meet CMS compliance and member expectations. As a subject matter expert, the role involves responding to requests from external and internal customers and facilitating resolution of issues or process improvements using multi-functional teams.

Hiring a Senior Cybersecurity Analyst to work independently and instruct other analysts, managing the support of information security systems and evaluating current systems. Requires expert knowledge of cyber security systems, networks, and applications. Provides work leadership and training to junior level cyber security analysts.