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 Relationship Manager
Summary of Job
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 (Required)
• Strong customer service experience with proven ability to build and maintain provider relationships (Required)
• Managed care, value-based payment model, quality, and population health management experience (Required)
• Excellent communication skills (verbal, written, presentation, interpersonal); ability to deliver complex information and achieve positive results (Required)
• Strong problem-solving capabilities (Required)
• Proficient with MS Office applications - Word, Excel, Powerpoint, Outlook (Required)
• Ability to travel up to 50% to meet with Providers and their representatives (Required)
Security Disclosure
If you are offered a job from one of the EmblemHealth family of companies that includes ConnectiCare, AdvantageCare Physicians, and WellSpark, the offer confirmation email will come from “HRTalentAcquisition” with the subject line: “Offer of Employment for (job title)” – Please respond online”.
We never ask you to join a Google Hangout, request you to purchase your own equipment or pay to apply. We do not send email from a third-party email service such as Yahoo or Gmail.
Pay Disclosure
A good faith estimate of the compensation range for individuals hired to work for the EmblemHealth Family of Companies is provided. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, internal peer equity, and market and business considerations. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. It is not typical for an individual to be hired at or near the top of the range, as compensation decisions depend on each case’s facts and circumstances. Union roles covered by a collective bargaining agreement will compensate in accordance with the union contract.
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/gender, sexual orientation, gender identity or expression, pregnancy or related condition, marital status, 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.