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.


To protect the health and safety of our workforce, members, patients, and the communities we serve, the EmblemHealth family of companies require all new employees to be fully vaccinated for COVID-19. Exemption/reasonable accommodations may be granted because of 1) a qualifying medical condition or disability that makes getting the vaccine unsafe for the individual, or 2) objection on the basis of sincerely held religious beliefs and/or practices.

Provider Relationship Manager

📁
Manager & Professional
💼
EmblemHealth
Sign Up for Job Alerts

Accountable for oversight and management of specific provider contracts in Provider Network Management. Lead day to day operations for all activities related to contracts, contract optimization, implementation of new programs and business ownership of all EPMO and IT projects associated with contracts. Foster strong relationships across EmblemHealth to advance the strategic goals of the organization. Provide regular check-ins with providers and their offices to ensure needs are met. Manage follow-up on outstanding issues and communicate back to provider/offices and EmblemHealth leadership.  Exercise good judgement to determine appropriate escalation of issues, anticipating provider needs. Advise leadership teams on emerging trends and issues. Partner with leadership to ensure organizational excellence.  Advise/implement departmental policies and protocols to enhance efficiency and effectiveness of workflows. 

Responsibilities:

  • Lead meetings with key subject matter experts (e.g., quality, risk adjustment, pharmacy and medical management) and delegate to implement new workflows, reporting requirements, regulatory changes, and new products
  • Lead joint quarterly and monthly meetings to review progress and performance opportunities with leadership.  
  • Improve the provider experience, in coordination with providers and with the plan through focused education and training, performance reporting, effective communication of new products, benefits, policies or initiatives, and resolution of provider issues across the business as the primary contact for the account
  • Manage relationships between Providers and Plan.
  • Identify and recommend system enhancements and process improvements resulting in savings and associated efficiencies. 
  • Drive provider performance and engagement through delivery of routine performance scorecards, reports, and population health data (e.g., attributed membership, physician rosters, and utilization).  
  • Responsible for updating trend reporting/dashboards/issue trackers.
  • Create strategies to improve key performance indicators; analyze performance data and identify opportunities and performance drivers.
  • Act as primary subject matter expert for each contract.
  • Work cross organizationally to ensure successful implementation of provider performance programs and agreements.  
  • Assure provider contractual relationships and obligations are maintained in compliance with regulatory requirements and EmblemHealth policies and procedures.  
  • Conduct annual contract reviews and amendments for assigned accounts as required to maintain current and accurate measures and benchmarks and targets in accordance with NYSDOH, CMS, NCQA, and other regulatory bodies.   
  • May train and guide staff in creating impactful relationship with provider partners
  • Monitor projects to ensure timely delivery to leadership. 
  • Work as lead for audits i.e. annual audit, CMS, RADV, Article 44, HEDIA/QARR etc.

Qualifications:

  • Bachelor’s Degree in a health services, healthcare administration, business administration or related field required
  • 5 – 8+ years’ experience in healthcare, plan or provider operations/administration/relations or related area (R)
  • Strong customer service experience with proven ability to build and maintain provider relationships (R)
  • Managed care, value-based payment model, quality, and population health management experience (R)
  • Excellent communication skills (verbal, written, presentation, interpersonal); ability to deliver complex information and achieve positive results (R)
  • Strong problem-solving capabilities (R)
  • Proficient with MS Office applications (Word, Excel, Powerpoint, Outlook) (R)
  • Ability to travel up to 50% to meet with Providers and their representatives (R)

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.

Previous Job Searches

Similar Listings

EmblemHealth

New York, New York

📁 Manager & Professional

EmblemHealth

New York, New York

📁 Manager & Professional

EmblemHealth

New York, New York

📁 Manager & Professional