Provider Relations Representative, Sr. jobs in Santa Maria, CA

Description

MUST BE ABLE TO COMMUTE TO SAN LUIS OPISPO AND WORK A HYBRID SCHEDULE THERE IN OFFICE 3 DAYS/WEEK

Salary Range: $101,007 - $151,510

Job Summary

The Provider Relations Manager plays a key role in establishing, cultivating, and maintaining positive relationships with CenCal Health providers. This position focuses heavily and intentionally on continuously curating and expanding a provider network which is highly satisfied and meets the needs of CenCal Health members through the development and deployment of ongoing education, the intake and resolution of complex provider issues, and a focus on effective and timely communication from the Provider Relations team.

The Provider Relations Manager oversees a combination of Provider Relations staff including Lead Provider Relations Representatives, Provider Relations Representatives, and/or Provider Relations Support Coordinators in multiple locations to ensure CenCal Health provides the highest level of service to its network.

Duties & Responsibilities

Provider Network Management

• Develop and maintain relationships with current and potential providers, including hospitals, physicians, and clinics.

• Conduct regular provider outreach and network reviews to ensure a thorough and up-to-date knowledge of the status of the CenCal Health provider network.

• Create and deploy strategies to enhance provider engagement and foster positive relationships with all current and potential CenCal Health providers.

• Ensure the timely, comprehensive, and satisfactory resolution of all provider issues for the assigned territory, including collaborating with other departments as needed and identifying and implementing interventions to minimize issues experienced by providers.

• Oversee service to providers including initial orientations, on-site visits, and email and phone support.

• Monitor and stay informed of provider’s performance in CenCal Health’s quality program and in support of timely access requirements.

• Support developing and deploying interventions to increase quality and access performance across the CenCal Health provider network.

• Collaborate effectively with Claims, Provider Services, and additional internal departments to ensure seamless provider support.

• Communicate effectively with providers to disseminate information, provide updates on health plan policies and procedures, and solicit feedback.

• Participate in JOC process development, data gathering, reporting, and analysis to provide JOC partners with current data related to provider performance.

• As requested, prepare provider network reports for Senior Leadership.

Provider Network Development

• In partnership with the Provider Relations and Provider Services leadership teams, identify opportunities to expand the CenCal Health provider network in support of improving access to care across all provider types.

• Oversee and conduct provider recruitment activities to continuously expand the provider network.

• Ensure close collaboration with credentialing and contracting functions so that new providers onboard timely and in a manner that best meets their needs.

• In collaboration with the additional Provider Relations Manager, own the end-to-end provider recruitment and onboarding process, including the establishment of service level agreements, timelines for communication follow-up, and processes for escalation with the Provider Relations Director.

Staff Oversight and Management

• Manage day-to-day activities of Provider Relations Representatives who recruit, contract, educate, maintain, and improve provider participation and satisfaction in an assigned territory.

• Provide guidance and support to Lead Provider Relations Representatives in strategic customer service, provider network engagement, education, and training.

• Responsible for ensuring that all direct reports adhere to customer service standards and represent CenCal Health in a consistently professional manner.

• Work side-by-side with PRRs to support preparing recommendations for provider problem resolution and the composition of communications to providers, as needed.

• Monitor task completion and recommend and implement improvements to processes and workflows for direct reports.

• Provide oversight of Provider Relations staff, as applicable, including leading, developing, coaching, and engaging direct reports.

Qualifications

Knowledge/Skills/Abilities

• Existing and strong knowledge of the CenCal Health Service Area, with a preference for knowledge of specific providers and network dynamics.

• Understanding of provider reimbursement models, contracting processes, and regulatory requirements.

• Excellent communication, presentation, negotiation, and interpersonal skills.

• Strong supervisory skills, including performance management.

• Relies on extensive experience and judgment to plan and accomplish goals.

• Effective problem-solving skills.

• Ability to multi-task in a fast-paced environment and strong time management skills.

• Proficiency in MS Windows Word, Excel, and PowerPoint applications

• Strong organizational skills

Education & Experience

• Bachelor’s Degree or at least 4 years of health plan, or health care experience

• Five (5) years’ experience in a Medi-Cal-managed healthcare setting, including working with healthcare providers required.

• At least Three (3) years of direct or indirect supervisory experience in Provider Relations, Member Services, or related health care or public health field.