Network Adequacy and Access Analyst


Community Health Group is a locally based non-profit health plan that ensures access to high quality, culturally sensitive health care for underserved communities throughout San Diego County. We treat our 300-member, multi-lingual staff like family, encouraging an atmosphere of collaborative teamwork, continuous learning, personal growth, and promotion from within. Recognized as one of the Top Workplaces in San Diego, CHG offers its employees such benefits as tuition reimbursement, a meditation room and yoga classes, a monthly Breakfast With The CEO, and memorable events throughout the year. 

We know that by serving our employees well, they, in turn, will better serve our nearly 300,000+ membership. We have been recognized consistently for the excellence and sensitivity of our customer service by members, physicians, vendors, and a full range of health care providers. We are accredited by the National Committee for Quality Assurance and proud of our continuing company-wide Quality Initiatives.

We are currently recruiting for:

Network Adequacy and Access Analyst

POSITION SUMMARY

This position will work with other departments and providers in order to comply with Timely Access standards and regulatory reports requirements. The Analyst will ensure adherence to regulations by overlooking Timely Access Plan activities and reporting outcomes to the Director of Customer Experience.

 

COMPLIANCE WITH REGULATIONS:

Works closely with all departments necessary to ensure that the processes, programs, and deliverables are accomplished in a timely and efficient manner in accordance with CHG policies and procedures and in compliance with applicable state and federal regulations including CMS, DHCS and DMHC. Implements key quality strategies, which may include but are not limited to initiation and management of providers and corrective action plans.

 

RESPONSIBILITIES

  • DMHC- Execution of Timely Access and Availability Program. Conducts
    Year over Year analysis and lessons learned (annual)

  • Conducts PAAS ensuring all steps of the DMHC methodology are followed

  • Updates Provider Contact Information for PAAS

  • DHCS 274 File- Execution of Timely Access and Availability Program (quarterly)

  • Pre-Natal- Execution of Timely Access and Availability Program (annual) Includes secret shopping

  • Responsible for CAP follow-ups and re-measurement of non-compliant and trending providers

  • Owner of Timely Access policies and procedures

  • Timely Access BPG Updates

  • Facilitates Timely Access Work Group meetings

  • Point of Contact for Third-Party Vendor activities (e.g. contract renewal, validation, file uploads)

  • Responsible for Narrative for Contact Lists

  • Responsible for Narrative for ANPR’s

  • Oversees Progress and Completion of Timely Access Report

  • Deliverables and Ensures Accuracy

  • Grievance Template
  • Contact Lists

  • External Vendor Validation Report
  • Communicates and works with Compliance Department to research, investigate, or implement any Timely Access updates/communication from Regulators

  • Analyzes and Trends Access Related Grievances

  • Analyzes and Trends Access Related Inquiries; identifies opportunities for provider re-training

  • Analyzes referral patterns to identify opportunities to optimize distribution

  • Identifies opportunities to add PCP’s, Specialists, Ancillary, NPMH Providers

  • Provider Newsletter Articles- Timely Access Standards & other reminders

  • Member Newsletter Articles- Timely Access Standards & other reminders

  • Conducts onboarding and ongoing training of staff and providers in regards to appointment availability standards

 

Education:

Bachelor’s Degree

Experience:                                    

  • Knowledge of DMHC and DHCS Access and Availability Standards and methodology

  • Experience with CAP monitoring and follow-up activities

  • Experience with Regulatory Audits and meeting deadlines

  • Extensive experience working with providers; management and executive staff

     

Skills:

  • Excellent verbal and written communication skills

  • Strong interpersonal skills

  • Knowledge of regulatory processes and expectations 

  • Ability to manage multiple projects at any given time

  • Ability to deal with sudden and upcoming changes and deadlines

     

Physical Requirements

  • Prolonged periods of (up to 100%) sitting while performing duties
  • Periodic (up to 25%) standing and walking
  • Occasional traveling
  • May be required to work evenings and/or weekends.