Provider Relationship Manager-Health Plan

Location: Portland, ME
Date Posted: 10-26-2016
Position Summary:
The Provider Relationship Manager acts as the primary liaison between company and its network providers.  The Provider Relationship Manager is responsible for establishing, building and maintaining strategic relationships with primary care providers, specialty groups, hospitals, their physician organizations and key health systems. The Provider Relationship Manager is part of the Network Management team and works in concert with the other areas of the organization, including our Health Management Department, government program product leadership and health plan operations to help drive organizational strategy and performance.
Key Outcomes:
  • Establish, build, and maintain positive working relationships with providers through conducting regular contact with and visits to provider sites
  • Takes ownership of the provider relationship to drive strategic objectives, including but not limited to:
    • Develop effective measurement and accountability systems to monitor health system/provider performance and identify opportunities for improvement.
    • Identify, initiate and oversee health system/provider-specific performance improvement plans
    • Establishes regular meetings with key Health Systems
    • Facilitates problem resolution as appropriate and necessary, working with internal and external partners
    • Uses data and reporting to engage providers in driving performance and accountability on key strategic initiatives
    • Educates provider network on shared objectives, industry knowledge and perspectives (e.g. risk adjustment and Star ratings), and reporting and performance measures
    • Uses business, industry, and environmental knowledge to inform conversations
  • Supports day-to-day provider network contract negotiations in partnership with contracting leader
  • Works with Director, Network Management to develop and implement provider strategy in alignment with Health Plan strategic objectives.  This may include service area expansion, recruitment of primary care or other providers, or other key activities.
  • Provides market and competitive intelligence as learned
  • Performs data analysis and develops specific actions to help drive performance measures including but not limited to risk adjustment, Star ratings, total cost of care, patient experience, and other quality measures
  • Understands Health System and provider business objectives and creates conversation on how their objectives align with those of the company.
  • Provides operational support to key business leaders in the Health Plan to help drive initiatives such as risk adjustment and star ratings
  • Informs leadership and other internal team members of provider interactions, engagement, and performance
  • Provides assistance to internal teams on development and delivery of provider communication
  • Serves on internal cross-functional work teams and/or committees when necessary
Education/Experience Requirements:
  • Bachelor's degree preferred or equivalent work experience required; MHA or MBA preferred
  • 5+ years field sales experience or provider relations experience, with a proven track record of establishing, building, and managing accounts required
  • Proficiency in Microsoft Word, Excel, and Access Office Products
  • Excellent oral and written communication skills
  • Significant proven advanced knowledge of managed care contracting, reimbursement methodologies, and negotiating strategies
  • Knowledge of the managed care/ health care industry
Skills/Knowledge/Competencies (Behaviors):
  • Demonstrates an understanding of and alignment with company values.
  • Strong negotiations skills
  • Excellent interpersonal skills
  • Excellent presentation skills
  • Ability to work independently
  • Ability to organize and execute multiple activities simultaneously
  • Ability to work under pressure
  • Problem-solving skills
  • Demonstrated ability to work independently to meet goals
  • Strong collaboration skills
  • Valid drivers license (no restricted or suspended license)
  • Ability to travel with potential overnights at least 75% of the time
Very competitive salary and benefits!
Great company to work for!
Full relocation package is available!
Don't miss out! Apply now and we'll be in touch immediately with more specific details, salary information and to answer any questions!!

This position does NOT provide sponsorship so please do NOT apply if you require sponsorship.  Thank You

KP Recruiting Group 
"Bringing Talent to the Marketplace"

KP Recruiting Group is a well established and very respected recruiting firm.  We have built a strong reputation as a premier resource for providing highly qualified candidates for our clients.  We are very experienced in many industries and have a wide range of clients.  We will serve as your advocate during your career search!  Let us do the work for you!  There is never a fee for our services!

this job portal is powered by CATS