Job SummaryThe Senior Specialist, Provider Network Management is responsible for building and maintaining strategic relationships with Priority Health's most complex provider partners. This role serves as a trusted advisor to providers and internal stakeholders, leading the resolution of complex operational challenges while supporting quality and provider incentive programs.
The Senior Specialist demonstrates advanced healthcare industry knowledge, strong business acumen, and the ability to influence outcomes across departments. This individual serves as a mentor to team members, an Epic Super User, and a key contributor to provider engagement.
Essential Responsibilities
Account Ownership & Provider Relationships
Serve as the primary relationship owner for Priority Health's largest, most complex provider partners.
Build trusted partnerships with executive and operational leaders.
Lead Joint Operating Committees (JOCs) and operational forums.
Anticipate provider needs, identify emerging risks, and proactively develop solutions.
Complex Operational Issue Resolution
Lead the resolution of complex provider operational issues involving multiple internal and external stakeholders.
Navigate ambiguity while maintaining productive relationships.
Facilitate cross-functional problem-solving.
Escalate and manage issues appropriately to ensure timely resolution.
Quality & Provider Incentive Programs
Serve as a subject matter expert for provider incentive programs.
Partner with providers to support performance improvement efforts and program understanding.
Interpret and communicate quality and incentive program results, opportunities, and operational impacts.
Support implementation of strategic initiatives that improve provider and member outcomes.
Epic & Process Leadership
Function as an Epic Super User.
Identify opportunities to improve operational efficiency and provider experience.
Provide recommendations to reduce provider abrasion.
Team Development & Leadership
Onboard and mentor new team members.
Share best practices and operational knowledge across the Provider Network Management team.
Provide guidance and informal leadership on complex provider issues and escalations.
Serve as a resource and coach for Specialists and newer team members.
QualificationsRequired
Bachelor's Degree in health care administration, business administration, accounting, finance, clinical or health and human services or equivalent education and experience
5 years of relevant experience of either provider network management experience, health care insurance or other health care delivery setting
Preferred
Provider or Payer experience.
Experience with provider incentive programs.
Experience facilitating executive-level meetings.
Experience managing complex provider relationships and operational challenges.
Demonstrated ability to lead meetings, presentations, and stakeholder discussions.
Strong analytical and problem-solving skills.
Familiar with Microsoft Excel skills, including V Lookups and Pivot Tables
Excellent written and verbal communication skills.
Ability to influence without direct authority.
Experience with Quality programs.
Primary Location
SITE - Priority Health - 1239 E Beltline Ave NE - Grand Rapids
Department Name
Provider Network Management - PH Managed Benefits
Employment Type
Full time
Shift
Day (United States of America)
Weekly Scheduled Hours
40
Hours of Work
8 a.m. to 5 p.m.
Days Worked
Monday to Friday
Weekend Frequency
N/A
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