Bachelor's degree is required.
The Provider Relations Manager is responsible for managing all provider relations requirements for US Family Health Plan provider network consistent with Plan requirements and operational needs.
Manage and maintain a high performing provider relations team that reflects the brand and values of US Family Health Plan.
Has authority to hire, evaluate and discipline provider relations staff who report to this position.
Responsible for overseeing all provider relations activities.
Oversees all provider contracting activities for US Family Health Plan. This includes but is not limited to identifying providers to participate consistent with plan objectives, negotiating terms within pre-determined parameters, and preparing and executing contract documents.
Responsible for training and supervising provider relations staff.
Responsible for developing and executing provider relations strategies in order to achieve/maintain high provider satisfaction.
Oversees provider credentialing as performed by third party administrator and ensures that providers are credentialed and in good standing.
Plans, coordinates and, as needed, conducts regular educational and outreach meetings for providers and their office staff regarding plan management. Requires travel to provider offices.
In collaboration with the management team, identifies performance improvement opportunities within the network to enhance plan operations.
Manages the communication of all benefit, operations and information updates to US Family Health Plan providers on an ongoing basis.
Participates in team meetings and departmental activities to support Plan goals and objectives.
Performs other activities including special projects, report generation, and event participation as needed for marketing and external services to support Plan goals and objectives.
Demonstrates respect and regard for the dignity of all patients, families, visitors, and fellow employees to ensure a professional, responsible, and courteous environment.
1.Commits to recognize and respect cultural diversity for all customers (internal and external).
2.Communicates effectively with internal and external customers with respect of differences in cultures, values, beliefs and ages, utilizing interpreters when needed.
Performs other duties as assigned
REQUIRED KNOWLEDGE & SKILLS:
Strong interpersonal, organizational and communication skills required.
Excellent computer skills required, especially with Microsoft Office applications such as Word, Excel, PowerPoint, and Access.
Ability to supervise and manage provider relations staff.
Ability to demonstrate and exercise independent judgment and decision-making.
Ability to manage multiple projects on an on-going basis.
Excellent interpersonal skills, including the ability to work across the organization and interact effectively at all levels of management and peers.
Negotiating experience required, particularly in a managed care environment.
Analytical and decision making skills
Must have use of vehicle, with ability to travel within the service area as needed.
I. Education: Bachelor's degree required. RN degree helpful.
II. Experience (Type & Length): Minimum of seven to ten years of provider relations and contracting, and experience in managed care environment
III. Certification/Licensure: n/a
IV. Software/Hardware: Microsoft Office applications (Word, Excel, Access, PowerPoint)
V. Other: Must be able to obtain U.S. Government personnel security clearance as a condition of employment.
Steward Health Care