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.

Provider Network Operations Manager

Manager & Professional
190E2 Requisition #
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Manage approximately 50 – 75 provider groups based on membership attributions adhering to EmblemHealth’s provider network management strategy.  Take overall responsibility for provider performance management.  Advance EmblemHealth in the provider market through a positive provider experience by furthering the goals important to practices including administrative ease, quality and risk score improvement (QIP), cost efficiency, VBP and practice management.  Represent and advance Emblem’s interests in the provider market as the preferred plan through superior customer service and execution of provider engagement strategies.  Develop and manage a high performance network and utilize various provider strategies that follow four core principles: Provider and Member Engagement, Quality/Risk Score Improvement, Administrative Efficiency and Cost Effectiveness.

  • Visit and assist providers to manage quality and risk score improvement (QIP), cost efficiency, VBP and practice management. Manage territories and evaluate network performance based on a solid business perspective.
  • Ensure appropriate reports are available that allow practices to better manage their member population (member roster, care plans, quality reports, access to population health data, etc.).
  • Communicate EmblemHealth’s benefits, policies, changes, and potential downstream effects to providers through field visits and conference calls.
  • Follow up on all provider issues, questions, inquiries and facilitate resolution.  
  • Work collaboratively with internal departments to facilitate resolution as needed.
  • Demonstrate a clear understanding of EmblemHealth’s model, its supporting systems, and how they impact provider practices.  
  • Apply critical thinking skills to solve problems with logical and analytical discipline.
  • Facilitate regular meetings with providers and other follow-up meetings with internal departments.
  • Ensure that decisions from external partner meetings are appropriately implemented to meet or exceed goals and expectations.
  • Provide timely reports, account analyses and industry best practices to develop effective and successful network account strategies. 
  • Recommend and identify new business opportunities with existing or new partners to management.
  • Identify and resolve critical bottlenecks to agreed-upon contractual obligations and negotiated deliverables while providing succinct reporting to executive leadership.
  • Collaborate and coordinate with Operations, Clinical, Finance and Sales, and other functional areas in the execution of all contractual or negotiated deliverables.
  • Performs other job-related duties as required.
  • Bachelor’s Degree in Business Administration, Healthcare Management, or related field 
  • 4 to 6 years industry-related experience required
  • Knowledge of regulatory guidelines affecting the healthcare industry preferred
  • Effective presentation skills required
  • Ability to manage multi-task operations/projects in a fast-paced changing environment, critical thinking skills required
  • Ability to manage time well between field and in-house days required
  • Excellent interpersonal and relationship building skills 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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