Provider Relations Manager
Job title: Provider Relations Manager
Reports to: Director of Provider Services
FLSA Classification: Exempt
The Provider Relations Manager is responsible for development and management of activities that sustain Emtiro Health’s provider networks and payer communications. These activities include, but are not limited to, assisting payers with provider network recruitment/development, provider engagement, education and training, and serving as the liaison to Emtiro Health’s clients in both the provider and payer communities. This position works collaboratively with all Emtiro Health departments as needed. This position is responsible for the Provider Relations program oversight, and will require frequent visits and contact with contracted practices, providers and payers.
Duties and responsibilities
Manages, directs and mentors Provider Relations staff on a day-to-day basis so that department-specific organizational objectives are met.
Oversees Provider Relations services as listed in Statements of Work (SOWs) to ensure compliance with service contracts and to build sustainable relationships with providers and contracted payers.
In consultation with the Director of Provider Services, develops and establishes guidelines and measures for Provider Relations that align with Quality Improvement goals and organizational objectives.
Recruits and engages providers in network development, per payer contract specifications. This responsibility most frequently focuses on efforts to increase provider participation in educational updates regarding payer policies and Medicaid Managed Care program updates.
In collaboration with the Chief Medical Officer, Director of Clinical Services, Director of Business Intelligence and contracted payers, develops and directs delivery of provider education and training, specifically in areas regarding performance metrics and NC Medicaid Advanced Medical Home program requirements. Conducts trainings, as appropriate, via remote or live techniques.
Works collaboratively with Emtiro Health’s Chief Medical Officer to develop, coordinate and oversee potential ECHO™ projects that address complex clinical conditions (e.g. opioid abuse, child mental health, diabetes, etc.)
Assists The Directors of Clinical Services and Quality Improvement with development, implementation and maintenance of strategies supporting provider satisfaction.
Serves as a liaison between Emtiro Health and provider/practice to identify and resolve performance-related issues. Performance-related issues may be from either Emtiro Health’s delivery of services on the provider’s behalf, or from the provider’s performance related to reportable quality measures.
Works collaboratively with all Emtiro Health departments and divisions on relevant cross-functional activities and projects.
Represents Emtiro Health and Provider Services in a positive, professional, collegial manner.
Other duties as assigned by the Director of Provider Services.
Minimum of three years of provider engagement or healthcare customer service work.
Minimum of two years supervisory or management experience; experience managing remote staff preferred.
Bachelor's Degree in related field; Master’s degree preferred.
Demonstrated knowledge of NC Medicaid Managed Care, Medicare Quality Payment Programs, and commercial value-based incentive programs.
Excellent quantitative and analytic skills with ability to synthesize complex information to create and evaluate options.
Strong knowledge of value-based payment models, managed care, quality improvement processes and NC Medicaid Advanced Medical Home program preferred. Knowledge of NCQA standards helpful.
Ability to build and manage high-performing field teams.
Experience working in a fast-paced, self-driven, dynamic environment, while maintaining focus on key goals.
Ability to work independently as well as in a collaborative team-oriented environment.
Excellent organizational skills, including ability to prioritize tasks to meet deadlines.
Excellent oral and written communication skills (i.e., public presentation skills).
Ability to diplomatically recognize and address effectively sensitive performance and practice management issues.
Strong relationship building skills to influence and work collaboratively with providers, health system representatives, payer staff and internal colleagues.
Ability to manage multiple projects and activities on a routine basis, with minimal supervision.
Valid NC driver’s license, reliable transportation and proof of insurance.
This position will be in an office setting during normal office hours, with occasional evening and/or weekend work. Frequent interaction with various practices should be expected. Most practices will be in a normal office setting; however, the Provider Relations Manager should expect varying office types and locations, requiring travel and occasional out-of-region in-person meetings.
This position may require lifting of up to 25 lbs. Long distance walking should be expected when visiting hospitals or larger practices/clinics.
Provider Relations Specialists.
How to apply
Interested candidates should send cover letter and resume to email@example.com with the subject line Provider Relations Manager.