Provider Network Specialist jobs in New York

CINQCARE

NYS Provider Network Development Specialist

Position Description

Overview

The Provider Network Development Specialist reports to the Director of Network Management with accountability for providing strategy, judgment, organization, and evidenced-based analysis to influence decisions, and directly to meet CINQCARE requirements. They should embody CINQCARE’s core values, including, Trusted, Empathetic, Committed, Humble, Creative and Community-Minded. At CINQCARE, we don’t have patients or customers – we have Family Members.

The Provider Network Development Specialist initiates, negotiates and executes participating provider agreements for IPA, ACO and other product offerings to expand the provider network’s market footprint as well as CINCARE’s Value Based Payment arrangements in the assigned region. 

This position will communicate contract terms, payment structures and reimbursement rates to providers.  Identifies and recruits providers based on target communities. Advises leadership on the development of functional strategies and matters of business significance. Has familiarity with the assigned region including market intel, provider contacts and existing relationships. Maintains an active pipeline of qualified providers to recruit. Exercises independent judgement and decision making on moderately complex issues regarding job duties, analysis of variable factors and works under minimal supervision.

Job Responsibilities

The Provider Network Development Specialist will have the following responsibilities:

• Develop mutually acceptable set of goals and objectives for provider recruitment in key NY communities by product line offering (e.g. Medicaid, Medicare, ACO REACH, PACE, MAPP/DSNP, MSO)
• Maintain a comprehensive list of network targets for outreach and leads that will drive success and market penetration. Provide regular updates, respond to inquiries, and address all account concerns in a timely manner
• Document and memorialize outreach efforts as well as contacts, provide status changes and new developments at team meetings
• Conduct market analysis and evaluate competitor’s practice and market status
• Develop strategies to be the preferred provider in  the market vs. the  competition
• Maintain complete organizational knowledge and product and services familiarity
• Add value by conveying useful industry, government and practice innovation trends and initiatives
• Assure Provider satisfaction
• Meet or exceed individual target goals and departmental objectives

General Duties

The Provider Network Development Specialist shall have the following duties:

• Leadership: Lead in defining and executing strategies and solutions to create business value in assigned area, including identifying and collaborating with key team members to design, develop, and execute those strategies and solutions to deliver desired outcomes.
• Strategy: Active participant in establishing the business strategy and roadmap: (1) improve outcomes for family members; (2) enhance the efficacy of other CINQCARE . business divisions; and (3) develop and deliver external market opportunities for CINQCARE products and services. In establishing the business strategy, the Provider Network Development Specialist will be an active participant in defining and contributing to the innovation of sustainable revenue models to drive profitability  for the Company.
• Collaboration: Ensure that the provider recruitment strategy is aligned with company objectives by working closely with other business divisions to learn their needs, internalize their knowledge, and define solutions to achieve the business objectives of CINQCARE NY
• Knowledge: Provide subject matter expertise on market landscape and intel, including determining and recommended approaches for provider outreach, engagement, relationship management, information sharing, overcoming roadblocks and closing contractual arrangements.
• Culture: Is accountable for creating a productive, collaborative, safe and inclusive work environment for the Provider Network  team and as part of the larger Company.

Qualifications

The Provider Network Development Specialist should have the following qualifications:

• Education. Bachelor’s degree in business administration or other related field;

• Experience. Minimum of 3-5 years experience in managed care or other health care related network development position(s). Appreciation for details with ability to read and understand provider contracts. Experience with Value Based Contracting;

• Entrepreneurial. CINQ seeks to fix gaps that have persisted for generations in the delivery of care to Black and Brown populations. This position is accountable for ensuring CINQ is positioned to innovatively deliver on its promise by influencing stakeholders and working closely with them to determine acceptable outcomes;

• Communication. Excellent written and verbal communications skills. Experience giving detailed reports and presentations. Competency using computer software to facilitate presentations and reporting. Excellent planning, organizational, and time management skills;

• Relationships. Ability to build and effectively manage relationships with business leaders and external constituents as well as internal stake holders and team members;
• Culture. Good judgement, impeccable ethics, and a strong team player; desire to succeed and grow in a fast-paced, demanding and entrepreneurial Company.

Location: The position is based in New York and requires travel to provider offices.

Compensation:  $85k - $110k