Provider Engagement Manager(PEM). If you are passionate about your work; eager to have fun; and motivated to be part of a fast-growing organization in Roseburg, OR, then you should consider joining our team
Overall Purpose:The Provider Engagement Manager (PEM) is responsible for establishing new relationships with affiliated clinic leadership, providers and staff as well as maintaining strategic relationships with affiliated providers and their office staff currently in the P3 network. The PEM will work closely with departments and collaborate with Operations, Care Management, Quality, Risk Adjustment & Clinical Documentations and Compliance teams to ensure organizational goals are achieved though effective management and development of assigned clinics/groups and working through their teams to achieve this end.
Roles and Responsibilities - Serves as the key stakeholder and primary contact in establishing and maintaining relationships with the affiliated clinic leadership, providers, and staff.
- Accountable for evaluating provider/clinic performance and developing strategic plans tailored to the unique needs of each group/clinic; to drive performance improvement and achieve progress towards organizational goals, MCR/MLR initiatives and opportunities for improved delivery of care to patients.
- Drives provider performance improvement in the following areas: documentation accuracy and specificity, HEDIS/Quality, medical cost and institutional and specialty utilization, etc.
- Responsible for triaging and effectively escalating provider issues both internally and externally as needed.
- Coaches and performance manages assigned team on effective communication and consultation with affiliate leadership and providers, helping to problem solve identified opportunities and issues as they arise.
- Responsible for management of project team and coordinating efforts to maximize effectiveness based on the skills of the staff and the needs of the group/clinic as they relate to the overall goal of the project, region, and organization.
- Updates dashboards for reporting purposes, identifies areas of underperformance, and contributes to developing/executing plans to correct.
- Organizes and assists in facilitating Joint Operations Committee meetings with assigned affiliated clinics and monthly operating review meetings with executive leadership and key stakeholders.
- Promotes and provides education, training, and remote / in-person support to Affiliate groups regarding the P3 care model, MRA, Medical/Care Management, Growth and P3 services and programs.
- Responsible for ensuring compliance with company and CMS regulatory requirements and mandates.
- Other duties as assigned.
Knowledge, Skills, and Abilities:- The ability to interact with, support, and influence positively the behaviors and activities of referring clinicians, industry partners, leadership, and staff.
- Result-oriented individual who strategically pursues business with energy and drive and can contribute to the growth and success of a rapidly growing organization.
- Extensive experience in diverse managed care organizations with understanding of key drivers of performance.
- Proven expertise in managed care and value-based models of care.
- Clinical operations experience preferred including operational metrics and financial understanding.
- Strong customer service skills, is customer service driven, has a positive attitude and is a clear and effective communicator.
- Strong analytical, critical thinking, and problem-solving skills.
- Understands the principles of CMS, HEDIS, NCQA, Health Plan Quality Standards and HIPAA required
- Familiarity of federal, national, state, and health plan regulatory requirements, as well as managed care and health plan standards required
- Familiarity with Medicare Advantage and special needs programs
- Highly professional in appearance, tone of language, and delivery of communication.
- Exceptional organizational and time management skills, with ability to prioritize to meet deadlines.
- Strong follow-through and results tracking to achieve measurable goals. Has an incredibly high degree of delivering on commitments to internal and external stakeholders, upholding the highest degree of integrity.
- Ability to maintain strict confidentiality in all job-related matters.
- Ability to interview and identify talented individuals to recruit into the team and then coach and mentor teammates to ensure success
- Must be an exceptional listener, with the proven ability to problem solve issues discussed.
- The ability to work both independently as well as in a group setting, high integrity, reasoned and thoughtful judgment, a sense of urgency and analytical and intuitive skills.
Education and Experience - Bachelor's Degree in Health Care Administration, Business Administration or Health Service or equivalent experience required
- 7+ years of experience in the health care industry working with an: IPA/Medical Group, Healthplan, or hospital; preferably with direct physician interaction.
- 5+ years of combined experience in Medicare Advantage, CMS and/or CMMI programs such as Accountable Care Organization Model or DCE models required.
- Experience in physician practice management, pharmaceutical sales, medical device sales or similar is strongly preferred.
- Proficiency with MS Office suite, and related software tools. Ability to learn new technical skills as needed.
- Confidence and comfortable with public speaking. Strong verbal and written communication required.
- 5+ years supervising, managing, and hiring teams.
Work Conditions:- Availability to travel within assigned region and work from multiple providers offices up to 90% of work schedule.
- Must have a valid driver's license, safe driving record, and able to furnish reliable transportation.
Physical Requirements - The work environment consists of exposure to physical conditions typical of a normal office environment. Most of the job is performed while sitting and talking/listening on the phone, although the work may require occasional standing or walking and/or the lifting and carrying of small objects up to 25 pounds.
Pay range: $85,000-100,000 depending on experience
