Location:

Work from home (Pennsylvania)

Shift:

Days (United States of America)

Scheduled Weekly Hours:

40

Worker Type:

Regular

Exemption Status:

Yes

Job Summary:

Represents the Health Plan and Provider relationship at the highest level. The position will work on complex issues where analysis and strategy require significant evaluation and collaboration. Responsible for establishing and maintaining Strategic Partnerships with Providers, communicating the vision and goals of the health plan, and supporting the development of the highest possible provider partnerships. In addition, the incumbent is expected to provide professional and exceptional service to our provider network.

Job Duties:

• Serves as a primary relationship manager with providers to ensure a positive provider experience and promote network retention.
• Supports new assigned providers with onboarding, including orientation session(s).
• Responds to assigned provider questions or inquires, and if necessary, ensures prompt resolution to provider issues with appropriate teams to drive results.
• Monitors data, presents reports, and encourages ongoing provider engagement through regularly scheduled touch bases and meetings. Reports regularly on referral volume by channel, tracking activity and effectiveness of outreach.
• Works with Providers across all areas including financial performance and value based programs.
• Resolves the most complex provider issues and collaborates with internal teams to drive to resolution.
• Influences strategy not just for their providers, but also for the department.
• Partners with quality improvement department for delivery of quality results and value based program results.
• Prepares in depth analysis and make decisions on complex issues.
• Creates strategic plans for providers in order to support the goals of the health plan.

Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

*Relevant experience may be a combination of related work experience and degree obtained (Associate’s Degree = 2 years; Bachelor’s Degree = 4 years).

Position Details:

Education:

High School Diploma or Equivalent (GED)- (Required), Bachelor's Degree- (Preferred)

Experience:

Minimum of 7 years-Relevant experience* (Required)

Certification(s) and License(s):

Skills:

Builds Relationships, Communication, Computer Literacy, Critical Thinking, Group Presentations, Health Insurance