Under general guidance from the Director, Provider Services, the Manager, Provider Services has direct oversight of the Provider Relations Representatives and the Provider Relations Coordinator. . This position for managing and building long-term relationships with delegated groups, directly contracted physicians, ancillary providers and their staff in a positive and proactive manner in order to support their understanding and compliance with Alliance contracts, policies, and procedures. The Manager partners with other departmental Managers and Directors on all matters as they relate to provider relations services and programs.
Principal responsibilities include:
· Provide day-to-day supervision to the Provider Relations Representatives.
· Manage daily functions of Provider Relations Coordinator
· Monitor and report Provider Relations Representatives’ monthly and quarterly metrics to management staff.
· Periodically attend site visits with PR Reps for staff development and quality assurance.
· Develop provider training materials in collaboration with Provider Services staff.
· Develop materials for provider quarterly packets.
· Provide oversight of provider trainings, monitor goals and ensure department and company standards are met.
· Ensure PR representatives meet minimum provider visit standards.
· Manage monthly new provider credentialing reports to ensure New Provider Orientations are conducted within timeframe.
· Monitor, evaluate and complete written performance evaluations of direct reports.
· Monitor accuracy of provider materials and information on the Alliance website.
· Participate in additional department projects as needed
· Maintain the Provider Relations policies and procedures to meet strategic goals and ensure regulatory/contractual compliance; help design, develop, manage and improve the Department's performance, policies and procedures.
· Foster and maintain proactive positive relations throughout the provider network by communicating with provider offices through face-to-face visits, letters, telephone calls, faxes or emails for the purposes of promoting the Alliance, sharing data and information about the physician’s practice, Alliance processes and other miscellaneous updates as well as for gathering information and feedback from the provider about any issues or concerns related to the Alliance or healthcare in general.
· Effectively identify, direct, and/or research provider operational issues for timely resolution per Alliance and state requirements through a thorough knowledge of all areas of Alliance operations and a strong working relationship with other departments.
· Assess the composition of the existing network, the opportunities for expansion in assigned territories and the availability of services in the surrounding communities to provide a comprehensive overview and understanding of the medical community to both internal and external customers.
· Recruit both new providers for participation in the Alliance network and existing providers for new lines of business and/or projects.
· Arrange for and conduct office manager group seminars and physician seminars and meetings including such tasks as scheduling a meeting space, locating speakers and preparing invitations, agendas, presentations, and handouts.
· Report from databases and other resources to provide information about the network to internal and external customers.
· Contribute to the development of written communications for the provider bulletin, manual, website and other publications and ad hoc reports and letters. Monitor accuracy of provider materials and information on the Alliance website.
· Supervise in-house projects, mailings and special projects as assigned.
· Participate in internal and external workgroups and meetings.
· Perform other duties and special projects as assigned.
ESSENTIAL FUNCTIONS OF THE JOB
· Identify and research a variety of issues related to provider contracting, compliance and operational issues utilizing various sources including, but not limited to, current contracts, publications, websites, etc. Report information in an appropriate manner either via reports, letters or verbal communication.
· Prepare and deliver verbal presentations in a group or one-on-one setting to Alliance network providers and their staff.
· Schedule and perform provider outreach visits, trainings and orientation sessions to comply with Alliance and State requirements.
· Frequent driving of automobiles between the worksite and provider offices.
· Perform writing, administration, analysis, and report preparation.
· Problem identification and resolution.
· Excellent verbal and written communication skills.
· Lead and participate in internal and external committees and meetings.
· Comply with the organization’s Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.
· Supervise and train staff
· Develop and maintain strong working relationships with providers
· Communicate effectively and efficiently, both internally and externally.
· Constant and close visual work at desk or computer.
· Constant sitting and working at desk.
· Constant data entry using keyboard and/or mouse.
· Frequent use of telephone headset.
· Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.
· Frequent lifting of folders and objects weighing between 0 and 30 lbs.
· Frequent walking and standing.
· Frequent driving of automobiles.
EDUCATION OR TRAINING EQUIVALENT TO:
· Bachelor’s Degree in Health Care Administration or Business or related field required.
· Minimum five (5) years job experience in provider relations for a managed care health plan, or government managed care, or IPA/medical group administration or related healthcare environment.
· Minimum three (3) years of directly supervising a staff of employees in a managed care environment required.
SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):
· Excellent written and verbal communication and presentation skills and exercise sound judgment.
· Strong interpersonal, organizational, analytical and problem-solving skills.
· Healthcare experience working with a Medi-Cal HMO plan highly desirable.
· Knowledge of provider relations responsibilities in a managed care setting.
· Customer service oriented and resourceful.
· Ability to work with others while completing multiple tasks simultaneously and successfully.
· Ability to make decisions in the absence of detailed instructions and work independently or in a team environment.
· Proficient in the use of Microsoft Office products (Word, Excel, Outlook, PowerPoint, and Access).
· Experience in HEALTHsuite preferred.
· Valid California driver’s license, auto registration, and proof of insurance required.
· Must be able to attend meetings both during and after regular work hours, both at or away from the worksite.
$77,710 - $116,570/annually