Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

Network Relations Account Manager

📁
Network & Contracting
💼
ConnectiCare
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Serves in an account management (non-sales) role as the primary business to business liaison between ConnectiCare and its provider network and is responsible for all interactions between the organizations.  Continuously educates provider community about ConnectiCare and its policies and procedures. Build and develop partnerships with ConnectiCare’s Tier I and Tier II providers, driving engagement and advocacy.  The Account Manager develops and maintains an ongoing collaborative relationship with providers, based on mutual respect, high quality outcomes, patient satisfaction and reporting. The Account Manager plays a vital role in achieving positive outcomes in the market. 

Responsibilities:

  • Develop and maintain positive business relationships with Tier 1 providers, and support of Tier II providers in alignment with departmental objectives.  
  • Oversee the compliance and participation of network physicians to ensure providers are responding timely and accurately to global requests made by any and all departments within the organization.
  • Actively manages and facilitates external Provider Collaborative meetings; including organizing and internal preparation; in order to improve overall population health in the areas of total medical cost management, quality and patient satisfaction. 
  • Responsible for oversight of the resolution of any and all escalated problems, including those identified by the providers, and those identified internally that have an impact on the assigned provider organizations. Coordinates with internal business partners to assist as appropriate, including creating project plans, issue logs, conference calls, etc. 
  • Works to continually shape the Network landscape, by education to all stakeholders in the market 
  • Ability to collaborate with the Contracting team to review contracts to gain understanding and communicate intent to providers. 
  • Drives continuous provider education and knowledge about ConnectiCare plans and products, ensuring full understanding; Promote wholesale policy change, and develop educational programs on a routine basis. 
  • Balance the interests of CCI with providers 
  • Performs other related duties and projects as assigned 

Qualifications:

  • Bachelor’s Degree required, or equivalent combination of education and experience
  • At least 3 - 5 years of previous experienced in managed care, health plan operations in provider contracting, provider relations, customer service, or claims required
  • Ability to work independently, prioritize and manage projects in a demanding, fast paced environment required
  • Strong problem-solving skills coupled with the ability to facilitate resolution to issues required
  • Understanding of health insurance products, claims payment and reimbursement methodologies required
  • Excellent communication skills, including presentation and education required
  • Strong interpersonal skills required including ability to affect change in a dynamic health care environment required
  • Demonstrated proficiency in MS Office suite as well as other related software applications required

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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